2024/25 NHS priorities and operational planning guidance: what you need to know

Summary and analysis of NHS England’s operational planning guidance and priorities for the service in 2024/25.

28 March 2024

Key points

  • On 27 March 2024, NHS England (NHSE) released its operational planning guidance for 2024/25, outlining the priority areas and objectives for the service.

  • We welcome recognition of progress and ambitions set out in the guidance. We also know leaders share NHSE’s determination to improve access to care and deliver more efficient services. There are concerns about how achievable the plans will be in the current context, but leaders are keen to build on the progress made in the last year.

  • Threats of further industrial action, including among general practitioners, long waiting lists and ongoing wider sector pressures, such as in social care, means 2024/25 is likely to be another tough year for all local services, their finances and ability to meet new stretching targets. For instance, increasing the performance target on four-hour waits to 78 per cent and requiring 95 per cent of diagnostic tests to be delivered within six weeks by March 2025, neither of which were achieved over the last year. 

  • Despite this, the support organisations and systems will require to recover and make inroads against the targets listed, as well as locally defined priorities, is not clear. To give the NHS the best chance to recover, the government must end the industrial dispute that continues to impede progress on waiting lists, ensure system leaders have access to sufficient capital funding, increase investment in general practice and increase capacity in social care.

  • A central theme of the planning guidance is improving productivity. It confirms NHSE will report on productivity metrics at a national, ICB and trust level starting from the second half of the year. ICBs will also be asked to report on how well trusts are improving the primary–secondary care interface. NHSE should consider how to make these reporting processes as efficient as possible to maximise staff time.

  • While we support the focus on productivity and recovering A&E performance, there is a risk that focus is drawn away from some of the important actions outlined around increasing capacity in primary and community services and reducing health inequalities that will support the development of integrated pathways of care and improved health outcomes.  

  • Looking ahead, given the clear impact of industrial action and uncertainties around the coming year, we recommend the objectives set out in this guidance are kept under review. In addition, that the government and NHSE aim to avoid publication of this guidance only days before its required implementation.



Priorities for 2024/25

NHSE’s overall aim in 2024/25 is around recovery of core services and productivity and asks systems to focus on the following priorities:

  1. Maintain collective focus on the overall quality and safety of services, particularly maternity and neonatal services, and reduce inequalities in line with the Core20PLUS5 approach.
  2. Improve ambulance response and A&E waiting times by supporting admissions avoidance and hospital discharge and maintaining the increased acute bed and ambulance service capacity that systems and providers committed to put in place for the final quarter of 2023/24..
  3. Reduce elective long waits and improve performance against the core cancer and diagnostic standards.
  4. Make it easier for people to access community and primary care services, particularly general practice and dentistry.
  5. Improve access to mental health services so that more people of all ages receive the treatment they need.
  6. Improve staff experience, retention and attendance.

Integrated care boards (ICBs), trusts and primary care providers are expected to work together to plan and deliver a balanced net system financial position in collaboration with other integrated care system (ICS) partners. 

On recovery, NHSE refers systems to the already published plans for elective care; urgent and emergency care (UEC); NHS dentistry; and access to primary care, which set out essential actions. System plans are asked to reflect the needs of all age groups, including children and young people. The guidance promotes NHS IMPACT, NHSE’s new, single, shared NHS improvement approach to develop the leadership and organisational capacity, capability and infrastructure to create the conditions for improvement and deliver a small number of centrally led national programmes..

On the workforce, the need to improve bank management and reduce temporary staffing usage (especially off framework) is a priority. Alongside the key focus on staff experience and further improving retention, the guidance asks employers to consider implementing the new national pregnancy and baby loss people policy framework (with further guidance on menopause to follow). Work to improve the working lives of doctors in training (which is supported by NHS Employers, part of the NHS Confederation) is flagged. NHSE also reminds the NHS of the importance of its EDI transformation plan, published last year.  

On improving productivity, NHSE expects ICBs and providers to work together to develop plans that deliver efficiency savings, raise productivity and implement more productive and flexible working practices, with a ‘relentless focus on improvement, reducing delays and unnecessary processes’. NHSE will report on productivity and supporting metrics at a national, ICB and trust level starting from the second half of 2024/25, with the intention to expand this to primary, community and mental health services. They will also work with systems on plans for the technology investment announced in the 2024 Spring Budget from 2025/26.

On transformation and planning for the future, the guidance proposes the following priorities:

  • Expand evidenced-based approaches to prevention, self-care and the effective management of long-term conditions.
  • Join up care closer to home through integrated neighbourhood teams and place-based arrangements. 
  • Integrate and streamline UEC pathways with a focus on the management of older people with complex needs and frailty.
  • Continue to drive improvements in productivity and operational effectiveness.
  • Work with higher education institutions and placement providers on key actions from the NHS Long Term Workforce Plan.
  • Continue to support the levelling up of provider digital maturity, connect services to the NHS App, and engage with the national Federated Data Platform team.

National NHS objectives for 2024/25

The guidance includes 32 objectives, covering 12 areas. View the priorities in the table below (click the + symbol to expand): 

Click on the image below to access our table comparing 2024/24 objectives with 2023/24, including our commentary.

Planning guidance objectives 2024/25 screenshot

The following sections summarise NHSE’s key evidence-based actions to support delivery of the national objectives for 2024/25.

Quality and patient safety

  • Systems are asked to implement the Patient Safety Incident Response Framework in the development and maintenance of incident response policies and plans. Key actions: 

    • Complete the NHS IMPACT self-assessment and create a plan for embedding improvement.
    • Ensure each organisation has robust governance and reporting frameworks in place. 
    • Embed a robust quality and equality impact assessment process.
    • Improve engagement of patients and families in incident responses. 
    • Use the new Learn From Patient Safety Events (LFPSE) service to support learning. 
    • Support the uptake of training under the NHS Patient Safety Syllabus.
    • Ensure the insight patients bring is embedded by appointing at least two patient safety partners to safety-related governance committees.

Recover core services

  • The Delivery plan for recovering UEC services sets out actions for systems to improve A&E waiting times and Category 2 ambulance response times. Systems are also asked to reduce the proportion of waits over 12 hours in A&E compared to 23/24. Key actions for systems: 

    • Maintain the capacity expansion delivered through 2023/24, including through maintaining acute bed and ambulance capacity, improving access to virtual wards and expanding intermediate care capacity.
    • Increase the productivity of acute and non-acute services across bedded and non-bedded capacity, improving flow and length of stay, and clinical outcomes. 
    • Develop services that shift activity from acute hospital settings to settings outside an acute hospital for patients with unplanned urgent needs, supporting proactive care, admissions avoidance and hospital discharge.

    Funding details

    NHSE will operate an incentive scheme for providers with a Type 1 A&E department achieving the greatest improvement and/or delivering over 80 per cent A&E four-hour performance by the end of the year.

    Additional funding made available to support capacity in 2023/24 is recurrent in 2024/25.

  • Key actions for systems to improve timely access to primary care and community health services as per ambitions in the delivery plan for recovering UEC services and the delivery plan for recovering access to primary care:

    • Empower patients, including encouraging the use of community pharmacies for lower acuity and common conditions and supporting expansion of patient choice at the point of referral.
    • Implement Modern General Practice Access, including supporting practices to ensure people can more easily contact their GP practice..
    • Build capacity, including establishing a full understanding of demand and capacity in primary care.

    To support recovery of primary care and community services, systems are also asked to: 

    • develop a comprehensive plan by June 2024 to reduce the overall waiting times for community services, including in waits over 52 weeks for children’s community services
    • support implementation of faster data flows, submitting timely, accurate data to provide a better understanding of long waits
    • implement annual sight tests within special day and residential schools and dental checks within special residential schools during 2024/25, following engagement and market testing. 

    Funding details

    The 2024/25 GP contract changes will support delivery of these priorities around access and NHSE will publish detailed guidance to support implementation. 

    Specific funding has been made available for the annual sight tests and dental checks in 2024/25. 

    NHSE will apply a ringfence to NHS dentistry budgets for 2024/25 and collect monthly returns from ICBs to establish current and planned spend against the dental allocations budget. For 2024/25 there is a new patient premium for taking on new patients, ‘golden hello’ incentives to encourage dentists into under-served areas and support practices with the lowest rates of payment, and new dental vans for the most isolated communities.

  • Trusts should have a designated lead for the primary–secondary care interface and deliver the access to primary care recovery plan to streamline the patient pathway. ICB boards are asked to regularly review progress.

  • Key actions for systems to support elimination of 65-week waits by 30 September 2024, as well as reducing the overall list size and improving productivity: 

    • Make significant improvement towards the 85 per cent day case and 85 per cent theatre utilisation.
    • Shift the balance of outpatient activity towards clock-stopping, ensuring the wait to first appointment continues to reduce. To meet the national ambition of 46 per cent systems are asked to deliver a 4.5 percentage point improvement against their 2022/23 baseline up to a maximum local ambition of 49 per cent. 
    • Have an established approach to ensure referrals to secondary care are appropriate.
    • Improve patient and list management so that at any time at least 90 per cent of patients waiting over 12 weeks are validated.
    • Continue expansion of patient choice at the point of referral, with patients offered a choice of five providers where appropriate, actively encouraging access to non-local NHS providers or the independent sector. 

    Individual system activity targets are the same as those agreed for 2023/24 before adjustment for the impact of industrial action, consistent with the national value-weighted activity target of 107 per cent. 

    Funding details

    To cover the cost of increased activity, the contract default will be to pay for most elective activity delivered at unit prices. 

    NHSE will allocate £3.2 billion of the Elective Recovery Fund to ICBs and regional commissioners on a fair shares basis.

  • Key actions for systems to improve standards and continue recent progress on early diagnosis: 

    • Improve productivity in priority pathways - lower GI, skin and urological cancers.
    • Establish breast pain pathways and unexpected bleeding pathways for women receiving HRT, for those who do not require a full clinical assessment on an urgent suspected cancer pathway.
    • Ensure the transfer of funding responsibility from cancer alliances to ICBs for the recurrent commissioning of key services.
    • Support delivery of NHS-wide early diagnosis programmes.
    • Work with cancer alliances and providers to implement a regular demand and capacity assessment of systemic anti-cancer therapy.

    Key actions for systems to support screening and capacity: 

    • Ensure NHS screening programme workforce and diagnostic requirements are included in planning. 
    • Increase screening colonoscopy capacity and contrast-enhanced MRI capacity for the Very High Risk NHS Breast Screening Programme. 
    • Increase uptake and coverage of screening programmes, including community diagnostic centres and women’s health hubs.

    Funding details

    Cancer plans by alliances are expected to form part of wider local system plans. Cancer alliances will receive £266 million of place-based service development funding (SDF), as well as targeted funding for specific initiatives.

  • Key actions for systems in working towards the elective care recovery plan target of 95 per cent of patients receiving their tests within six weeks and agreeing improvement trajectories with NHSE:

    • Complete the opening of all new and upgraded community diagnostic centres, as well as new acute imaging and endoscopy capacity.
    • Complete the planned digital diagnostics investments including digital pathology, laboratory information management systems (LIMS) and MRI acceleration, improving productivity in pathology and imaging networks.
    • Utilise new capacity to commission a significant expansion in GP direct access.
    • Focus wider new capacity on specialties with significant waiting lists, seeking to implement one-stop diagnostic testing ahead of first outpatient appointments and a maximum ten-day turnaround time from referral to report for urgent suspected cancer patients.
  • Key actions for systems to deliver the Three-year delivery plan for maternity and neonatal services

    • Make progress towards the national safety ambition to reduce stillbirth, neonatal mortality, maternal mortality and serious intrapartum brain injury.
    • Reduce inequalities in experience and outcomes for the most affected groups.
    • Increase fill rates against funded establishment by growing and retaining the maternity and neonatal workforce, and invest in the skills and capacity to provide high-quality care.
    • Agree safe staffing levels for the obstetric workforce in trusts, and support trusts to achieve them through action on recruitment and retention.
    • Ensure all women and families have personalised and safe care, with every woman offered a personalised care plan and being supported to make informed choices.
    • Implement best practice, including the revised National Maternity Early Warning Score and Newborn Early Warning Trigger and Track tools.
    • Develop a positive safety culture, including regular board-level review of the progress of a focused plan to improve and sustain culture. 

    For 2024/25 and the following two years, systems and services are asked to support implementation of the Maternity Safety Package, as announced at Spring Budget 2024.

  • Key actions for systems in recovering performance against CYP (children and young people) access, perinatal access, dementia diagnosis and the existing waiting time standards for CYP eating disorder services:

    • Improve patient flow and reduce length of stay in adult acute mental health wards, based on ten high impact actions to drive improvements in flow and reduce delayed discharge.
    • Publish system three-year plans to localise and realign inpatient care in line with the mental health inpatient commissioning framework by June 2024.
    • Embed digital technology to transform pathways, provide more personalised and joined-up care, improve clinical productivity, and improve access, waiting times and outcomes. 
    • Improve timeliness and quality of mental health activity, outcomes and equality data, including data flows into the Mental Health Services Data Set from partner organisations. 

    Funding details

    ICBs are expected to continue to meet the Mental Health Investment Standard. NHSE has allocated funding to grow the workforce and expand services to support delivery of the NHS Long Term Plan commitments, including the additional funding in the 2023 Spring Budget and Autumn Statement to expand individual placements and support the digitisation and expansion of NHS Talking Therapies.

    In 2024/25 there will be an additional £70 million of SDF for CYP services, training new staff in critical roles, and a communications and engagement programme to raise the national profile of dementia. 

  • Key actions for systems: 

    • Reduce admissions of autistic people into mental health inpatient care and increase discharges into community settings so that the overall number of autistic people in hospital is lower. 
    • Discharge people with a learning disability with the longest lengths of stay into community settings and continue to reduce the number of people with a learning disability in hospital.
    • Ensure each learning disability annual health check is accompanied by a health action plan. 

Transform the way we deliver care and create stronger foundations for the future 

  • Key actions for systems on vaccination, immunisation and screening: 

    • Implement local MMR vaccination improvement plans and collaborative vaccination commissioning, so ICBs are engaged in preparation for delegation of functions in April 2025.
    • Put plans in place to maximise uptake of childhood and flu vaccinations for CYP and deliver any other vaccination programmes required by DHSC.
    • Support initiatives to increase uptake and coverage of screening programmes, including through community diagnostic centres and women’s health hubs. 

    Key actions for systems on prevention of ill-health and tackling health inequalities: 

    • Update plans for the prevention of ill-health and incorporate them in JFPs, with focus on Core20PLUS5 populations and NHSE’s high impact interventions for secondary prevention.
    • By the end of June 2024, publish joined-up action plans to address health inequalities and implement the Core20PLUS5 approach.

    Funding details

    Funding is provided through core ICB allocations to support the delivery of system plans developed with partners. The formula includes an adjustment to weight resources to areas with higher avoidable mortality and a recurrent £200 million of additional funding allocated for health inequalities.

  • Key actions for systems on improving staff experience, retention and attendance: 

    Key actions for systems to align workforce numbers to priorities and the financial resources, ensure robust provider establishment control measures and reduce temporary staffing:

    • Implement and evidence flexible, productive workforce and working practices across organisational boundaries, supported by digital solutions.
    • Reduce high-cost agency expenditure and increase use of collaborative temporary staffing approaches across systems. 

    Key actions for systems working with higher education institutions and placement providers, to support growth in the longer term:  to support growth in the longer term:

    • Deliver their share of the agreed increase in education places for nursing associates, advanced clinical practitioners and physician associates.
    • Complete the clinical expansion planning process and agree plans by clinical profession with NHSE to ensure alignment with system strategies and NHS Long Term Workforce Plan ambitions.
    • Plan for the necessary workforce expansion in every system from 2025, and utilise the education tariff to implement the Educator Workforce Strategy. 

    The guidance advises that system workforce numbers must be aligned to service priorities and financial resources available. Providers are expected to demonstrate robust establishment control measures and review any significant change with their ICB. NHSE expects to see a significant reduction in temporary staffing costs.

  • Key actions for systems: 

    • Level up digital maturity of provider organisations. Trusts with a completed outline business case to deploy their electronic health record system by March 2025.
    • Use the What Good Looks Like digital maturity assessment to support adherence to standards for well-led digital leadership and a smart foundation for basic digital infrastructure.
    • Support activity within the NHS Research Secure Data Environment Network, actively enabling the secure availability of linked, research-ready data. 
    • Support implementation of the Federated Data Platform (FDP) and work with the national team to align their data architecture and consider its potential in planning investments.
    • Connect services to and champion use of the NHS App and website as the digital front door, and maximise adoption of the patient engagement portal services.
    • Maximise adoption of the patient engagement portal services so that 80 per cent of all trust outpatient appointments are managed through the portal by March 2025.
    • Continuously improve core enterprise IT suites to remove the constraints of legacy technology. 

    Funding details

    NHSE plans to roll out the FDP to at least 70 organisations in 2024/25. Licences and the deployment of the core platform will be funded by the FDP programme.

    NHSE will work with systems to develop robust plans for the technology investment announced in the 2024 Spring Budget from 2025/26. 

  • ICBs should work with providers to develop impact assured plans that meet the minimum 2.2 per cent efficiency target and raise productivity, including completing an analysis of current productivity compared to 2019/20. Key actions: 

    Operational and clinical productivity

    • Improve whole-system flow, transform elective care, and improve productivity in priority cancer pathways and diagnostics. 
    • Implement best practice service models in community services to improve outcomes and secure better value, including through expansion of virtual wards.
    • Leverage opportunities such as digital therapy to provide more high-quality care within existing capacity in mental health services. 
    • Reduce low-value interventions in line with evidence-based interventions guidelines

    Workforce productivity

    • Conduct an establishment review and develop an action plan to improve productivity, including reconciliation of staff increases since 2019/20, identifying the rationale for increases based on outcomes, safety, quality or new service models. 
    • Adopt best practice workforce deployment processes and improve meaningful use standards attainment by a minimum of one level through regular reviews and robust governance. 
    • Reduce temporary staffing costs and increase collaborative temporary staffing approaches across systems. 
    • Improve agency price cap compliance and by July 2024 trusts should end use of all off-framework agencies. ICBs to put in place governance for assuring plans and monitoring delivery.
    • Collaborate and share data on agency pay rates to improve agency price cap compliance and effective bank use. Staff should be encouraged to take up substantive roles wherever possible. 

    Efficiency savings

    • Optimise all-age continuing care placement pricing by reducing unwarranted variation, improved sharing of placement data and integrated ‘at scale’ commissioning practices.
    • Optimise medicine value through reviewing prescribing trends, increasing adoption of new generics and biosimilars and delivering against national medicines optimisation opportunities.
    • Make full use of published benchmarking data and improvement tools to reduce the cost of running corporate services per £100 million turnover.
    • Optimise energy value by channelling demand through the new national contract. 
    • Drive procurement and commercial efficiencies and value by working to accepted operating models and commercial standards, using NHS Supply Chain consolidated supplier frameworks and procuring from frameworks operated by an accredited host 

    NHSE will share core productivity and efficiency metrics with benchmarked opportunities for all acute providers with the intention to expand this to primary, community and mental health services. The initial draft metrics will be tested and further developed with systems and acute trusts.

  • Key actions for systems in building the components of system working: 

    • Develop core population health management capabilities and use joined-up data between primary and secondary care to support the implementation of the proactive care framework..
    • Develop local system architecture to support the delivery of JFPs including to support:  
      • primary care and community organisations to shape integrated neighbourhood teams
      • place-based partnerships to develop, in cooperation with wider public sector and non-statutory partners
      • provider collaborative arrangements, with the expectation that all NHS trusts and their boards work in at least one collaborative, with a focus on scale and transforming services. 

NHSE plans to provide a progress update against the recovery plans, including an evaluation of the key actions. Further support is available on FutureNHS.

Planning assumptions and funding

NHSE has issued updated revenue allocations for 2024/25. ICBs will continue to receive Service Development Funding (SDF) allocations. For 2024/25 this will continue to be bundled into high-level groupings. Further detail is set out in the revenue finance and contracting guidance

Core ICB capital allocations to 2024/25 remain the foundation of capital planning. Capital allocations will be topped up by £150 million nationally, in line with the incentive scheme for providers with a Type 1 A&E department. Further detail is set out in the capital guidance update 2024/25.

The contract default between ICBs and providers for most planned elective care will continue to be to pay unit prices for activity delivered. Activity targets will be agreed through planning as part of allocating ERF on a fair shares basis to systems.


NHS leaders share the ambitions set out in the planning guidance and will do everything they can to improve access to care and deliver more efficiencies. However, they are receiving guidance on how to plan for 2024/25 just one working day before the start of the new financial year. This delay is unhelpful and points to a limiting short-termist approach from the government to long-term planning for the delivery of healthcare. Although this year has been particularly challenging due to industrial action, the government should work with NHSE to avoid such a delay in future.

We welcome the ambition to continue to develop services that shift activity to settings outside acute hospitals and into prevention and early intervention

We welcome the ambition to continue to develop services that shift activity to settings outside acute hospitals and into prevention and early intervention; one of our members’ top priorities for the next government. We also support the inclusion of the NHS IMPACT work to provide national leadership and create the conditions for improvement. Particularly important is its inclusion not only as a productivity and cost reduction driver but as a key support for quality and safety. The NHS Confederation fully supports this and plans to build on the ambition alongside NHSE with our support offer for ICS leaders and improvement leads: Learning and Improving Across Systems; as well as our Primary-Secondary Interface Improvement Programme

We must also acknowledge that the financial environment for all of our members is exceptionally challenging. As our recent report highlighted, a series of non-recurrent measures were taken in 2023/24, many of which will not be available in 2024/25. There is also a challenging paradox in relation to workforce numbers: the NHS Long Term Workforce Plan describes the need to expand the NHS workforce, but financial requirements are driving plans with freezes on workforce numbers, or significant reductions. We will continue to make the case that a clearer and more careful narrative at national and regional level is needed to guide discussions regarding financial plans and workforce numbers, and which balances financial responsibilities (including assurance of financial controls) with the transition to what is envisaged by the long-term workforce plan alongside the safety and quality responsibilities being managed by our members.    

The operating context

The guidance recognises progress has been made and the challenging conditions that 2024/25 will bring. We particularly welcome the focus and acknowledgement of pressures on mental health services. Systems are required to include patients with mental health needs and children and young people in service recovery plans, and develop local plans to reduce long waits for and community and UEC mental health services. 

It is positive that NHSE acknowledges that many of the targets contained in the guidance are ‘stretching’. We therefore believe that plans should be kept under regular review to consider the evolving operating and financial environment. Increasing the performance target on four-hour waits from 76 per cent to 78 per cent by March 2025 feels particularly challenging, especially without access to additional capital funding in this financial year, and given the 76 per cent target has not been met during any month of 2023/24 so far. Similarly, maintaining the target of 95 per cent of diagnostic tests to be delivered within six weeks by the same date will be difficult given the most recent data shows in January 2024 only 74 per cent of patients waited less than six weeks.

There are significant barriers standing in the way of the NHS making further progress over the next year – not least industrial action which, if left unresolved, will continue to cause operational instability and risk harm to patients. On primary care, it is welcome to see no new targets, but a continuation of those commitments already published through the Primary Care Access Recovery plan. However, in light of the proposed contract settlement for 2024/25 and an increasingly tight financial context, the opportunity to do more in primary care is limited without additional investment. 

There are some fundamental issues the government must address to give the NHS the best chance to recover elective care and enable systems to drive overall improvements in the population’s health

It is unclear on the face of the guidance how organisations and systems will be supported to recover and make inroads against the targets listed in the guidance, as well as locally defined priorities. There are some fundamental issues the government must address to give the NHS the best chance to recover elective care and enable systems to drive overall improvements in the population’s health. These begin with ending the industrial dispute that continues to impede progress on waiting lists, finding the capital funding to deal with our crumbling estate and maintenance backlog and increasing capacity in social care so that fewer patients are left in hospital when they should be cared for closer to or in their homes.

In terms of system planning requirements, it is positive to see an emphasis on the role of the voluntary, community and social enterprise sector in supporting delivery of system priorities via an ask for ICBs develop a plan for working with the sector to drive transformation. More generally, while it is encouraging that NHSE has offered ICSs support in developing updated Joint Forward Plans (JFPs), the three-month turnaround for ICSs to refresh their JFPs is tight, especially given the capacity and financial pressures organisations at neighbourhood and place level are under. 

NHSE has confirmed it will shortly engage with systems on a new oversight framework with the aim of providing further clarity on the role of NHSE and ICBs in oversight and ways of working with providers. The NHS Confederation will support this process to help ensure oversight incentivises integration as well as service recovery.


The single biggest contribution - at least £1.5 billion - to last year’s system deficit was the ongoing industrial action. While it is not within the gift of NHSE to address this particular issue, there is little consideration for how further action might affect the objectives or what process will be put in place to reassess these metrics throughout the year. The guidance states that the NHS aims to end the financial year in a net-zero financial position. While an understandable goal, this fails to heed recent history – and the ongoing industrial action – in which financial planning rounds have had to be consistently revisited owing to both highly ambitious expectations from the centre on ICS leaders, and various unpredictable events. The challenged financial position of key ICS partners, notably local government, will all be a barrier to progress, especially in relation to social care and public health.

It is worth noting that the planned increase in capital spending for the NHS, as announced in the 2024 Spring Budget, will not be seen until the next financial year and only relates to technology and data. Although we look forward to systems leading work to make best use of the investment to bolster recovery and improve services for patients, we also know the service faces a maintenance backlog of over £10 billion, which will be a significant barrier to achieving the ambitions set out. 

Although ringfencing of funding is generally not conducive to support longer-term planning, we support this in the case of NHS dentistry budgets for 2024/25

Although ringfencing of funding is generally not conducive to support longer-term planning, we support this in the case of NHS dentistry budgets for 2024/25 given the dire state of provision, which is something our members are especially concerned about. In line with aims of ICSs on reducing health inequalities and improving population health outcomes, the focus within the planning guidance on vaccination programmes for children and adults is welcomed and will be enhanced by implementation of the vaccination strategy.

The continuation of the Mental Health Investment Standard is positive. However, given the tight financial envelope in 2024/25, mental health providers are concerned about the reality of this commitment. An additional £70 million of Service Development Funding, of which part will support increase children and young people’s access to services, is also welcome as this is a key area of pressure.

Incentivising productivity

The Chancellor announced the intention to set new productivity measures alongside the £3.4 billion productivity plan for the NHS in the Spring Budget. The planning guidance confirms that NHSE will report on productivity metrics at a national, ICB and trust level starting from the second half of the year, in line with the government’s productivity plan. We will work to support development of these metrics but speculate there is a chance of delay until after a general election, given their politically sensitive nature.

Where ICBs are asked to report on how well trusts are improving the primary–secondary care interface, NHSE should consider how to make these reporting processes as efficient and meaningful as possible

NHSE’s work to give a clearer picture of how productivity might be judged should be done in close cooperation with leaders who have the best understanding of their populations as well as the opportunities and levers available, in particular in developing new metrics for primary, community and mental health services. Where ICBs are asked to report on how well trusts are improving the primary–secondary care interface, NHSE should consider how to make these reporting processes as efficient and meaningful as possible to maximise staff time. 

While we support the focus on productivity and recovering A&E performance, there is a risk within this incentive structure that focus is drawn away from some of the important actions outlined around increasing primary and community care capacity and reducing health inequalities that will support the development of integrated pathways of care and improved health outcomes. In particular, targeting financial incentives (through additional capital) at those trusts delivering over 80 per cent performance on A&E four-hour waits, as well as the most improving trusts, does not reward all parts of the system that collectively hold the levers needed to address what is a system-wide problem.

Key actions for members

ICBs and their partner and foundation trusts are asked to work with wider system partners to develop integrated system plans to meet the national objectives set out in the guidance alongside local priorities agreed by ICSs and signed off by ICB and trust boards. Requirements for plan submission are set out separately. 

ICBs and their partner trusts are required to publish and share their JFPs with NHSE, integrated care partnerships and health and wellbeing boards by 30 June 2024. Guidance can be found on NHSE’s website.

Systems are asked work together to develop long-term infrastructure strategies, which will underpin JFPs and provide a system-level view of priorities for estates and capital investment by the end of July 2024. Guidance and resources can be found on NHSE’s website.

Members should also review the updated set of supplementary documents, which accompany the planning guidance.

How we will be supporting members

We will continue to engage with NHSE on behalf of members to represent their views and the reality of delivering services in the current environment. This includes continuing to advocate for further guidance and support on the areas not covered and call for greater recognition of the issues highlighted in our analysis, such as industrial action, productivity ambitions and funding.

We will also continue to support members with the implementation of guidance through our networks and forums, at every level across the system and our support offer for ICS leaders and improvement leads through the Learning and Improving Across Systems programme.

As one of our central asks of government, we will be focusing specifically on ensuring appropriate funding for the service over the next year. Building on our recent report on capital funding requirements, Investing to Save, we are assembling a member working group to test ideas for how the government might fund this ask and what innovative solutions we can offer. We invite any interested member to get in touch.  

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