HSJ’s round up of the day’s must read stories and debate
- Today’s target update: The A&E target won’t be met nationally in 2018-19
- Today’s finance update: Provider sector expected to balance as DHSC finds extra £540m
- Today’s in other news: NHS makes little progress cutting specialised income ‘long tail’
The 2018-19 NHS planning guidance was published both later and earlier than expected on Friday afternoon.
Later, because it normally comes out shortly before Christmas. Earlier, because last time it came out, in September 2016, it was supposed to last two years.
HSJ covered the document in depth.
The guidance revealed:
- The NHS has relaxed its trajectory for hitting the national accident and emergency waiting time standard, and will not hit the target in 2018-19. The planning guidance only committed itself to “return[ing] to 95 per cent overall performance within the course of 2019.
- For elective care the service is aiming only to ensure the total waiting list is no bigger in March 2019 than it is in March 2018. The number of year-plus waiters will also be halved, the planning guidance said. Tellingly, the flagship 18 week waiting time target isn’t even mentioned in the guidance.
- The NHS financial rules go through the wringer again - with a new sustainability fund for commissioners, changes to the STF, changes to CQUIN, and to a variety of other incentives you probably forgot existed.
- The planning guidance calls for substantial growth in elective activity but it also reveals workforce plans must remain affordable and trusts cannot spend above their agency ceiling. Given the 40,000 nursing vacancies and the scale of medical rota gaps, NHS trusts will face substantial pressures delivering that ambition. Staff will either have to work harder in 2018-19, or the target will be missed.
- Every clinical commissioning group in the country will be required to hit the “mental health investment standard”, to increase mental health spending at least as fast as their overall allocations. The Royal College of Psychiatrists said they fear that an increasing number of CCGs are not managing this, and the policy should reverse that trend. While it will not close the gap between the lowest spenders and the average, it should stop the disparity getting worse.
- There’s also room for a moment of jubilation - the Department of Health and Social Care has found another £540m from within its budget to put into the NHS in England funding allocation. It has thus far refused to say how it found this within its already tight settlement - get in touch if you know.
The guidance takes the opportunity to rebrand ACSs, because “accountable care” has become confusing, and toxic, with upcoming judicial reviews on the similarly American-sounding accountable care organisations.
NHS England said that the refreshed planning guidance “signals full speed ahead” for ICSs and is now accepting applications for the next cohort - not mentioning that wave two had already been delayed. The first wave must produce a single operational plan, and there is no mention yet of any transformation funding bonanza.