Member briefing: Operational priorities for winter and 2021/22

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24 / 12 / 2020

On 23 December, NHS chief operating officer Amanda Pritchard and NHS chief financial officer Julian Kelly wrote to NHS leaders with an update on the service’s operational priorities for this winter and into 2021/22.

The letter covers priorities for the rest of 2020/21, planning for 2021/22 and the 2021/22 financial framework. NHS England and NHS Improvement has confirmed to us that no planning returns are required in response to the letter, but it does contain some actions. This briefing summarises the key issues outlined in the letter and the actions required.

Key points

1. Priorities for remainder of 2020/21

The letter sets out five priority areas:

1.1. Responding to ongoing COVID-19 demand

Local organisations should continue to plan on the basis that we will remain in a level 4 incident for at least the rest of this financial year and NHS trusts should continue to safely mobilise all of their available surge capacity over the coming weeks.

Maintaining rigorous infection prevention and control procedures continues to be essential. This includes separation of blue/green patient pathways, asymptomatic testing for all patient-facing NHS staff and implementing the ten key actions on infection prevention and control, which includes testing inpatients on day three of their admission.

All systems are now expected to provide timely and equitable access to post-COVID-19 assessment services, in line with the
commissioning guidance.


1.2. Implementing the COVID-19 vaccination programme

Vaccinations should take place in line with JCVI guidance to ensure those with the highest mortality risk receive the vaccine first.

The NHS needs to be prepared and ready to mobilise additional vaccination sites as quickly as possible in the event that further vaccines are approved by the independent regulator.

COVID-19 vaccination is the highest priority task for primary care networks, including offering the vaccination to all care home residents and workers.

All NHS trusts should be ready to vaccinate their local health and social care workforce very early in the new year, as soon as authorisation and delivery of further vaccine is received. 

1.3. Maximising capacity in all settings to treat non-COVID-19 patients

Systems should continue to maximise their capacity in all settings. This includes making full use of the £150m funding for general practice capacity expansion. NHS trusts should continue to treat as many elective patients as possible, prioritising those who have been waiting the longest, while maintaining cancer and urgent treatments.


NHS trusts have already been notified of the need for a Q4 activity plan for their local independent sector site by Christmas and this should be coordinated at system level.

Clinical quality and safety should continue to be safeguarded and all NHS trust boards are required to consider the Ockenden review of maternity services and the 12 urgent clinical priorities at their next public meeting, along with an assessment of their maternity services against the review’s immediate and essential actions. 


1.4. Responding to other emergency demand and managing winter pressures

In addition to the previously announced £80m in new funding to support winter workforce pressures, systems are asked to take the following steps to support the management of urgent care:


  • Ensure those who do not meet the ‘reasons to reside’ criteria are discharged promptly. All systems are asked to improve performance on timely and safe discharge, as set out in a separate letter, as well as taking further steps that will improve the position on 14+ and 21+ day length of stay.
  • Complete the flu vaccination programme, including vaccinating staff against flu.
  • Continue to develop NHS 111 as the first point of triage for urgent care services in each locality, with the ability to book patients into the full range of local urgent care services
  • Maximise community pathways of care for ambulance services referral, as a safe alternative to conveyance to emergency departments.

1.5. Supporting the health and wellbeing of our workforce

Systems should continue to deliver the actions in their local People Plans and remind all staff that wellbeing hubs will mobilise in the new year in each system.

In addition to the above, all clinical commissioning groups and NHS trusts should have an SRO to lead the EU/UK transition work and issues should be escalated to the regional incident centre established for COVID-19, EU transition and winter.

2. Planning for 2021/22

Systems should continue to:


  • Recover non-COVID-19 services: an aspiration has been set that all systems should aim for top quartile performance in productivity on high-volume clinical pathways: ophthalmology, cardiac services and MSK/orthopaedics. Systems and trusts are asked to appoint a board-level executive lead for elective recovery to start preparing system-based recovery plans that focus on addressing treatment backlogs and long waits.
  • Strengthen delivery of local People Plans, and make ongoing improvements on: equality, diversity and inclusion of the workforce; growing the workforce; designing new ways of working and delivering care; and ensuring staff are safe and can access support for their health and wellbeing.
  • Address the health inequalities that COVID-19 has exposed. Systems will be expected to make and audit progress against the eight urgent actions set out on 31 July.
  • Accelerate the planned expansion in mental health services through delivery of the Mental Health Investment Standard together with the additional funding provided in the Spending Review for tackling the surge in mental health cases.
  • Prioritise investment in primary and community care, to deal with the backlog and likely increase in care required for people with ongoing health conditions, as well as support prevention through vaccinations and immunisations.

3. The 2021/22 financial framework

The financial framework for 2021/22 will have the following key features:

  • Revenue funding will be distributed at system level, continuing the approach introduced this year and consistent with the NHS Long Term Plan financial settlement. There will be additional funding to offset some of the efficiency and financial improvements that systems were unable to make in 2020/21.
  • Systems will need to calculate baseline contract values to align with these financial envelopes so there is a clear view of baseline financial flows. These should be based on 2019/20 outturn contract values adjusted for non-recurrent items. 
  • Systems and organisations should start to develop plans for how COVID-19 costs can be reduced and eliminated once we start to exit the pandemic.
  • System capital envelopes will also be allocated based on a similar national quantum and using a similar distributional methodology to that introduced for 2020/21 capital planning.

The financial numbers will be provided early in the new year in conjunction with fuller planning guidance once NHS England and NHS Improvement has resolved any further funding to reflect the ongoing costs of managing COVID-19. Further detail of non-recurrent funding announced in the recent Spending Review for elective and mental health recovery will also be provided at that point.

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