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“They’ve not moved the goalposts – they’ve taken the entire pitch!”

This was the response of one senior commissioner, a view representative of many of their colleagues, to the news that local systems will need to carry out more planned procedures to receive cash from the elective recovery fund following NHS England and Improvement’s decision to increase the activity thresholds required.

The activity thresholds that integrated care systems must meet to earn cash from the ERF are this month being increased to 95 per cent of 2019-20 activity levels from July 2021. This is up from the 85 per cent target set out in the planning guidance which first outlined the ERF scheme in March.

ERF will be paid at 100 per cent of tariff for above the 95 per cent threshold, and at 120 per cent of tariff above 100 per cent of 2019-20 activity, NHSE/I has told local system leaders.

National bosses said they had taken the decision after the service had made “excellent progress in restoring elective care whilst dealing with the significant increase in demand for urgent and emergency care”.

But some local leaders warned the move risked derailing ICSs’ efforts to cut backlogs, because recovery plans had been developed on financial assumptions set out in March and those assumptions had now been significantly changed.

One ICS leader warned it would have “a huge financial impact”. They said their ICS had built in a range of schemes and private sector contracts “off the back of the ERF scheme [but] that funding has just gone down the river. They have not just moved the goal posts, NHSE/I have taken the entire pitch!”

Unjustified variation

Are children within inpatient mental health units expected to be restrained more than adults?

A review by NHS England and Improvement’s Getting it Right First Time programme has found that patients within child and adolescent mental health units are 5.7 times more likely to be restrained than adults at the same trust.

So why the variation between adults and children? This is just one of the questions NHSE/I’s GIRFT report will ask of the system. Sources who have seen presentations of the report’s findings, yet to be published, have also said GIRFT identified significant variation in cost of beds across units and length of stay for children.

Children in more than a third of units stayed on the unit for an average of 60 days – the recommended time is much lower.

More importantly there was reportedly not one inpatient model which GIRFT could pick out as a preferred one. Does this perhaps suggest something about the NHS’ entire approach to children’s inpatient care?