Last year most primary care trust chief executives polled by HSJthought their local delivery plans were badly flawed by an operating framework delivered late and with significant errors in the tariff.

Last year most primary care trust chief executives polled by HSJthought their local delivery plans were badly flawed by an operating framework delivered late and with significant errors in the tariff.

The Department of Health is stressing that they won't be able to make such a claim this time. One of NHS chief executive David Nicholson's promises when he got the job was to deliver the operating framework before Christmas. And so he has. The favour he demands in return is that organisations use it to improve their planning for 2007-08.

Progress on the public service agreement targets is mixed and although the operating framework does not announce any new targets, the milestones on the 18-week targets and need for action on C. difficilewill both be tough, even in the last year of big growth in NHS funding.

In both cases trusts will need to shake off a habit exposed by the foundation trust diagnostic process - that of pinning all hopes on a best-case scenario, whether that is increasing activity levels or cutting costs.

The new operating framework's rule that cost improvement programmes should show half their savings in the first half of the year reflects a concern that too many boards will attempt to gain a surplus by pulling on the brakes too late. Most trusts' brakes simply are not good enough for that kind of treatment.

The successful foundation trusts have learned to plan more effectively. Mr Nicholson has said that all trusts should be acting as quasifoundation trusts next year - quality of planning and risk management will be a key test of that.

Topics