What NHS England isn’t telling you, and more indispensable weekly insight for commissioners, by Dave West
The planning guidance
Christmas is coming early. The NHS planning guidance, which we’re used to receiving just hours before we head home to put out Santa’s mince pie and sherry, is this year due to arrive within days from now.
OK, it’s liable to slip backwards, but not very far. So what can we expect from this unseasonal gift?
The emphasis will be on getting on with delivery, rather than encouraging any more planning (Irony alert: It’s still called planning guidance. Last year’s was titled Delivering the Forward View, so presumably this time it’s Now We Really Mean It.)
It will cover two years (April 2017 to March 2019) instead of the usual single year.
The move to ceremonially trash the planning rulebook – which says guidance must come each December, followed by months thrashing out contract terms – is aimed at getting this out the way with minimal dispute, then moving on to implementation. Rows over volume and value will be replaced with a harmonious realisation of proposals amicably agreed across the system, in sustainability and transformation plans (the fate of those whose STP has not been approved is a key unknown).
Also helping to shift focus from the minutiae is the fact many key rules will remain the same. The tariff uplift is already fixed (and two-year tariff consultation finished), allocations are known, sustainability funding is expected to be similar, and clinical commissioning groups must again sit on a chunk of their budget so it can be used for bailouts.
Of course, there will be some extra vroom behind reform: a more serious run at whole-system control totals, payment flexibility, a bit more co-commissioning, spreading new care models, assurance shifting to STPs, and perhaps some hints on what STPs will become in 2017. The NHS’s march away from its statute will go on.
A balance will have to be struck between a localist, instruction lite backing for STPs and the central requirements flowing from NHS England’s select priority areas (dementia, learning disabilities, mental health, diabetes, cancer, maternity/children, general practice, A&E, etc).
The most uncomfortable tension, though, will be as before – between reform and short term delivery. July’s “reset” document – effectively emergency mid-year planning guidance – was 80 pages, nearly all about financial savings and acute trust performance. Add a new prime minister seeking an NHS that is quiet over winter and financially balanced, and square that with the aspirations above.
What have I missed? You’ll find out before Christmas.
The Commissioner’s reading list
- Social care for older people – the King’s Fund and Nuffield Trust’s major report on social care strains
- Accident and emergency – from The Economist, a useful summary for an outsider of where the NHS is at
- Most areas should publish STPs by end of the year, says NHS England – summary of the full new guidance on STPs
- Procurement rules hope – Simon Stevens suggests Brexit might mean a change to competition requirements
Dave West, senior bureau chief