The Commissioner: Awaiting further instructions

As we await revised planning guidance for 2018-19, here are some suggested amendments to speed things along. For further details, please refer to the original 2017-19 guidance and Next Steps on the Five Year Forward View. Changes from the originals are in bold:

Our shared tasks are not quite so clear: implement the Five Year Forward View to drive improvements in health and care; restore and maintain financial balance (minus at least £800m annually); and pointedly not deliver core access and quality standards.

Right across the country except the North East, NHS organisations want to spend less of their time locked in adversarial and transactional relationships… We do now have the opportunity to settle the numbers earlier and for a longer duration. That said, they will now have to be settled again. Please try to agree by Christmas – do we really have to get you into the headmaster’s office again?

To ensure that organisational boundaries and perverse financial incentives do not get in the way of transformation, from April 2019 a few sustainability and transformation partnerships (or agreed population/geographical area) will have a financial control total that is also the summation of the individual organisational control totals. NB: yes, we have tried to announce this a few times before.

We will also go further and produce a bold, new, radical single view of finance and performance across both providers and commissioners every quarter, called ‘The Quarter’. NB: subject to various unspecified conditions.

2018-19 ‘Must Dos’:

Referral to treatment times and elective care: deliver the agreed trajectory in your system for the waiting list to reach 5 million by 2021 without extra money, as agreed in budget negotiations.

Mental health: increase baseline spend on mental health to deliver the mental health investment standard except where you really can’t.

Urgent and emergency care: frontline staff have pulled out all the stops, but over this past winter there have been real difficulties. So, we need to take action to improve services for patients and reduce pressure on our staff. Were there any actions you didn’t already try last year? If not, try them again. Systems will already be planning for next winter, where this has not been put on hold to deal with the current winter. Continue to repeat: in 2018-19, the NHS will be better prepared for winter than ever before.

Commissioning in the evolving system: Clinical commissioning groups’ role will continue to evolve. As new care models are established, the boundary between what is done by CCGs and by new integrated care providers will shift. However, there will continue to be a need for an effective commissioning function in the NHS. But we also told the Treasury that this reform business would save a shed load of management costs. Please merge immediately, cutting management costs in half (and without too much fuss).

Some areas are now ready to go further and more fully integrate their services and funding, and we will back them in doing so (called cuddly integrated care systems). In time, some CICS may never ever lead to the establishment of the hated and illegal accountable care organisations.

Sustainability and transformation funding: the provider sector is required to return to aggregate financial balance at some indeterminate point, including through use of the £1.8bn (and the rest) STF. This is again being made available to acute trust providers in perpetuity.

NHS 70: local systems are encouraged to hold tea parties and similar. Templates will be distributed. Why not invite senior political leaders to attend and make a major long term funding commitment to the NHS?