NHS Confederation responds to NHS England’s latest operational planning guidance

Responding to NHS England’s operational planning guidance for 2023/24, Matthew Taylor, chief executive of the NHS Confederation, said:

“No one should be under any illusions that 2023 will be one of the most challenging years the NHS has ever faced. The latest planning guidance comes at a time of unprecedented pressure, with the NHS facing a huge backlog of care, the twin threats of rising Covid and flu and now what looks like being a prolonged period of industrial action. As ever, NHS leaders will do all they can to meet these targets, but the big ‘known unknown’ is how disruptive industrial action will be. Failure to bring a speedy end to the dispute will inevitably halt the progress the NHS can make in recovering services.

“What will help NHS leaders though is the commitment from NHS England to reduce the number of national targets outlined in the planning guidance and to create more funding flexibility and space for local leaders to develop tailored priorities for their communities. These changes are in line with NHS England’s new operating framework and the Hewitt Review. This is the right approach and we are pleased to see the first down payment on it, with a much slimmer set of national targets and a greater emphasis on outcomes, with less prescription on how to achieve them. There are around 30 headline targets in this latest guidance which are clearly presented. This improves upon last year’s guidance and provides welcome clarity and direction for system leaders. However, we think there is further scope for reducing down the number of national targets in 2024 and beyond.

“While there are significant challenges ahead, NHS leaders will welcome the signal this guidance sends about the prospect of a new and improved relationship between local systems and the centre – one that is based on the right level of accountability from the NHS to government, the arms-length bodies and the taxpayer, but also with the right level of local determination to set tailored priorities for local communities. We are not quite there yet but this is a big step in the right direction, and we know the Hewitt Review will make recommendations about how this can be developed further.

“Much of our success in 2023 will hinge on delivering improvements in patient flow. The bed occupancy and discharge targets are challenging and will require local NHS and care services to work hand in glove to improve discharge capacity and processes, as well as investing in hospital avoidance schemes. But the blunt reality is that if social care markets continue to collapse in the way they have been, then some of the key targets outlined in the guidance won’t be achievable. We welcomed the government’s recent extra investment in social care, but that now urgently needs to be converted into more care packages for vulnerable people who desperately need social care support.    

“Similarly, the NHS is also going to rely on government support when it comes to another crucial challenge – dealing with the workforce crisis that we are experiencing. The guidance is right to target a reduction in agency spend – every NHS leaders wants to reduce expenditure here. But the truth is that until we finally get the workforce strategy that the government has now promised to publish next year, then NHS leaders won’t be able to magic-up new staff and will continue to have to rely on agency staff. The safety of their services requires them to do so.

“Getting the right numbers and skill mix of staff in place will also be critical in addressing the backlogs of care we are seeing across the NHS, not just in elective care. While the planning guidance is right to set out the ambition to go further and faster in reducing these backlogs, we are however concerned that returning to paying full unit prices reintroduces an element of Payment by Results. This is a retrograde step that risks undermining innovation, system working and value for money. Rolling more funding into system allocations is welcome, but longer-term NHS leaders will welcome more progress towards fewer ‘penny packets’ to help them plan, improve efficiency and get best value for money.”