Direction set for years ahead

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The government’s new mandate to NHS England and a series of decisions made by NHS England’s board on Thursday (17 December) have set the direction of travel for 2016/17 and beyond, establishing a degree of financial stability for the NHS.

The updated mandate – which outlines NHS England’s contribution to the government’s goals for the health and care system – is for the first time a multi-year directive. It is supported by a multi-year budget, as indicated in the Spending Review

Its publication came on the same day that NHS England’s board announced several critical decisions, including how the Sustainability and Transformation Fund of £2.14bn for 2016/17, recently established by the Department of Health, would be allocated. 

Of this, £1.8bn will be used to stabilise NHS operational performance and £340m for ‘transformation’, to continue the vanguard programme and invest in other key FYFV areas.

The decisions form the basis of the 2016/17 planning guidance, published on 22 December.

Below is a round-up of key points for members to note.

The NHS mandate in brief

Mental health and parity of esteem: Requirement to deliver the recommendations in mental health taskforce report, improve perinatal mental health, improve crisis care, and tackle inequalities. 

Clinical commissioning groups (CCGS): Development of ‘Ofsted style’ CCG assurance frameworks.

NHS England’s role in efficiency and productivity includes actions to take with CCGs, including:

  • roll-out of second cohort of RightCare methodology to a further 60 CCGs
  • work with CCGs to support Government’s goal to increase NHS cost recovery up to £500m by 2017/18 from overseas patients
  • ensure CCGs’ local estates strategies support the overall goal of releasing £2bn and land for 26,000 homes by 2020.  

Seven-day services: Measures for seven-day services, as set out in the summer. 

Innovation: Requirement to make progress next year on the security and sharing of patient data, “measurable improvement” in NHS uptake of affordable and cost-effective new innovations by 2020. 

Avoidable deaths: Programme to be developed for all trusts to reduce the numbers of avoidable deaths.

Driving improvements: Support the NHS to be the world’s largest learning organisation.

Building on the friends and family test, proposals will be developed on  how feedback – particularly in maternity services – could be enhanced to drive improvements to services at clinical and ward levels.

Also a requirement to significantly improve patient choice, including in maternity, end-of-life care and for people with long-term conditions.

Transformation: Several mentions of ‘transformation areas’ covering 20 per cent of the population, where urgent and emergency care networks, improved access to GP appointments and health and social care integration will be rolled out first. 

Primary care: By 2020, 100 per cent of the population is to have access to routine evening and weekend appointments, and 5,000 more GPs. Productivity is also to be improved, including through community pharmacy reform. 

Integration: 50-100,000 people to have a personal health budget or integrated personal budget (up from current estimate of 4,000). 

  • Better Care Fund funding from CCG allocation will be the same as last year. 
  • Every area to have an agreed plan by March 2017 for better integrating health and social care. 
  • Areas will graduate from the Better Care Fund programme management once they can demonstrate they have moved beyond its requirements, meeting the government’s key criteria for devolution.
Workforce: NHS England required to contribute to reducing the disability employment gap.

Targets: To 2020, A&E, ambulance and referral to treatment targets stay the same. In 16/17, a system-wide plan for reducing delayed transfers of care must be agreed, with local government and NHS partners implementing year one of this plan.

NHS England decides

At the final board meeting of the year, NHS England’s board confirmed the following measures:

  • An agreed cross-system efficiency profile, which will enable NHS England and NHS Improvement to consult on a net tariff efficiency of 2 per cent, as against 3.5 per cent to 3.8 per cent this past year.
  • Establishing a Sustainability and Transformation Fund of £2.14bn for 2016/17. Of this, £1.8bn will be used to stabilise NHS operational performance, and £340m for 'Transformation' to continue the Vanguard programme and invest in other key FYFV areas). 
The fund will grow from £2.1bn in 2016/17 to £2.9bn in 2017/18, rising to £3.4bn in 2020/21, with an increasing share of the growing fund being deployed on transformation including the FYFV's New Care Models, and mental health parity of esteem. 

The NHS England board will make decisions on allocating the STF for 2017/18 and beyond in the light of place based Sustainability and Transformation Plans to be developed by July 2016 across the NHS.

  • Real-terms funding increases for CCGs in every year, with firm allocations for the next three years and indicative allocations for the final two years.
  • Higher funding increases for GP services/primary medical care than for overall CCG growth, with the ability for CCGs to make further investments on top of this using the co-commissioning option.
  • Action is being taken to cut inequalities by improving the fairness of funding allocations to respond to unmet need. 

    • First by ensuring next year for the first time that no CCG is more than 5 per cent below their fair share funding, both in terms of their CCG-commissioned spending, and for the first time also taking account of their overall 'place based' population budget (combining primary, CCG-commissioned, and specialised care).
    • Second, factoring in the pressures facing CCGs with faster population growth. 
    • Third, taking full account of inequalities in resourcing for primary medical care. 
    • Fourth, introducing for the first time a new inequalities adjustment for specialised services. 
    • Fifth, factoring in the unavoidable pressures of rurality and sparsity.
  • Devolution: In Cornwall NHS England have had to issue legal directions to the CCG which will need to raise its game before it, the local council and local providers could realistically be asked to take on more responsibilities.

Find out more

View the NHS Confederation's response to the mandate and the NHS Sustainability and Transformation Fund.

Access the mandate in full from the Department of Health website.

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