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There are three big priorities for local NHS leaders, according to NHS England chief finance officer Julian Kelly last week. They were the vaccine programme, clearing “several thousand” blocked beds ahead of the oncoming winter, and ramping up elective activity to clear the backlog. 

He therefore made two major announcements while speaking at the Healthcare Financial Management Association. First, that he would give local leaders a free hand to stand up local initiatives and schemes to free up bed space, be that using hotel rooms or paying for someone to go into a care home.

“We need to see if we can mitigate and reverse the effect of the increase in blocked beds that we have seen,” Mr Kelly said. Trust and system leaders should press forward with their local schemes while assuring them that he would find a way to pay for them so that trusts can improve patient flow and cut ambulance handover delays.

On top of this, in the medium-term, he said increasing elective activity will be crucial. As a result, he said, there will be a “payment by results” component to the contract next year.

“It is a really important part of the contract that we have with government that we, if at all possible, meet the goals for activity that they have agreed with us as part of giving us £9bn. And we still think a strong volumetric element to paying for elective work is going to be central to that.”

This will mean the current emergency funding arrangement for the NHS comes to an end. The service has been paid through block contracts with the centre to cover provider costs during the pandemic.

Next financial year the health service will “get back to proper system ownership of the payment flows”.

Going nowhere fast

Data on discharges released for the first time by NHSE show the challenge faced by many trusts in discharging “medically fit” patients to free up beds for emergency or elective patients.

HSJ analysis of NHSE winter sitrep data released last week shows that at least a fifth of hospital patients at 31 trusts had been there for 21 days or more in the week of 29 November. Just 12 trusts were in this position during the same week last year.

NHSE says that more than one in 10 beds during the last week of November were occupied by patients who were medically fit to leave.

Further HSJ analysis of these new discharge figures reveals that, at 19 trusts, at least a fifth of their patients were medically fit for discharge in the week of 29 November.

At 13 trusts, at least 10 per cent of patients were both medically fit for discharge and had been in hospital for 21 days or more.