NHS England expects clinical commissioning groups to fund more hospital activity than initially planned this year, prompting concerns that this could undermine non-acute services intended to reduce emergency admissions.

  • NHS England expects 2-3 per cent growth in CCG funded elective and emergency activity
  • CCG leaders concerned about impact on out of hospital care plans
  • Paul Baumann admits NHS England’s 2014-15 plan did not have “enormous amount of realism”

The organisation said it expects up to 3 per cent growth in CCG funded elective and emergency activity compared to 2013-14, which is “considerably north” of commissioners’ current plans for this year.

In his report to NHS England’s board meeting last week, chief executive Simon Stevens said: “NHS England is working with CCGs to ensure that they commission realistic levels of activity growth, up front.

“As a result we are now expecting to see CCG funded elective and emergency activity growth in the 2-3 per cent range compared with 2013-14 outturn, which is considerably north of the figures in initial commissioner plans.”

He added that the “national aggregates… mask legitimate local variation, but in the round commissioners will be seeking to strike a pragmatic balance between assuming a continuation of current demand trends versus factoring in the expected impact of CCGs’ ambitious new programmes to moderate demand growth”.

Paul Baumann

The NHS’s activity plan is ‘not characterised by an enormous amount of realism’, Paul Baumann said

Chief financial officer Paul Baumann said NHS England’s activity plan in 2014-15 “was not characterised by an enormous amount of realism”, but it had sought to “strike a better balance” this year.  

A CCG finance director in the south told HSJ their organisation had in recent weeks been directed to plan for an increase of at least 2.2 per cent in non-elective admissions, while it had previously been asked to commit to reductions of more than 3 per cent.

They said the change had effectively “wiped out our [planned efficiency saving]”.

“All it does is pass the problem from provider to commissioner,” they added. If the direction from NHS England was designed to encourage commissioners and providers to work together to overcome problems, it could be helpful, but it appeared to be aimed only at the “political imperative to clear waiting lists and hit targets”, they said.

An NHS England source involved in the work said there was some concern that the “unusual move” to direct CCGs to change their plans would weaken groups’ relationships with national organisations.

That source said it could also undermine confidence in services planned as part of the better care fund to reduce emergency admissions, and raised the question of how CCGs would fund proposed funding transfers to local authorities, additional preventative services and continued emergency activity growth.

Bolton CCG chief officer Su Long said she was worried about CCGs becoming “less ambitious about the scale of the rollout of their joined up community care”.

“In the worst case, some CCGs may have to roll back on [better care fund] commitments… in order to plan for this much [acute] activity,” she said.

Ms Long added that CCGs would normally “plan to succeed and have a contingency fail”, but NHS England are this year “keen to plan for [the possibility of] failure upfront”.

“I think it’s fair of them to seek [for commissioners] to make plans either way, but if non-elective activity does go up we are all pretty bust, because more of the same increases just aren’t affordable.”

NHS Clinical Commissioners co-chair Steve Kell warned: “Expectations from the centre must be aligned to [CCG’s] current clinical plans to ensure they don’t knock them off course and impact on patient care.”

Dr Kell, who also chairs Bassetlaw CCG, said: “CCGs recognise the importance of funding care out of hospital, and we risk repeating the mistakes of the past by simply increasing funding going into hospitals.”

NHS England declined to comment.