The must-read stories and debate in health policy and leadership.

Trusts that miss their elective activity plans will be subject to higher payment deductions than were previously planned, under proposals published by NHS England.

As part of a move away from block funding arrangements introduced during the pandemic, providers will now see 75 per cent of funding deducted for activity which is not carried out, up from the original proposal of 50 per cent. Activity above the baseline stays at 75 per cent of the tariff rate in the new plans.

It followed a briefing to The Telegraph saying that NHS England had been pushing ministers to keep the deduction rate at 50 per cent, which quoted a government source saying: “There will be a laser-like focus on delivering value for money for the taxpayer.”

But NHS Providers said the changes could leave services “underfunded” if the new regime did not take account of local variation and factors outside a trust’s control, like pressures in social care and workforce challenges. Chief executive Chris Hopson warned a regime that was not “appropriately flexible” could see trusts “driven into financial problems that will affect their ability to deliver safe and effective care.”

111 Last?

The ambition for the 111 service to become a “primary route” into emergency departments has so far failed to live up to expectations, with only a small fraction of attendances being booked through it.

NHS England began recording the numbers of ED appointments booked via 111 in August 2020, as it aimed to reduce unnecessary attendances and demand on emergency services, via the programme known as “111 First”.

Planning guidance for 2021-22 told local systems to “promote the use of NHS 111 as a primary route into all urgent care services”. It added that at least 70 per cent of patients referred to ED by 111 services should receive a booked time slot to attend. 

Pilots experimented with making it harder for people who had not called 111 to attend A&E, although proposals to direct those people away were rejected.

Data published by NHSE shows the number of ED attendances that were booked through 111, but not those referred to ED without a booking. They suggest there was a large initial surge in bookings between August 2020 and March 2021, from around 1,400 to 32,000.

However, 32,000 represented just 3 per cent of total attendances, and the numbers have subsequently remained at around this level over the last year. Read our full story.

Also on today

The HSJ week ends as ever with an alternative take on events from Julian Patterson, who this week offers Sir Trevor Longstay’s seven essential qualities of leadership, and in the HSJ podcast Health Check we discuss the Care Quality Commission’s view that NHS trusts are getting better.