Doubts over plans to stop waiting list growing this year

NHS England chief financial officer Paul Baumann revealed the news as he presented a paper on the 2018-19 planning round to a joint board meeting of NHSE and NHS Improvement yesterday.

He said the “more challenging part [of the planning process] is whether the elective activity that has been planned for… is sufficient to deliver on the commitment we made that the waiting lists will be at worst stabilised”. This was particularly the case in commissioner plans, he said.

He said: “That is a piece of testing we will need to do in the context of real expectation in the coming weeks.”

During winter, the government and NHS England were at loggerheads over what performance on key targets could be asked of the NHS within the funding available.

The final deal was reflected in planning guidance for 2018-19, which said the referral to treatment waiting list should be “no higher in March 2019 than in March 2018”.

This follows several years of the list growing, and in November – before the Budget – NHSE chief executive Simon Stevens warned the government that: “On the current funding outlook, the NHS waiting list will rise to 5 million people by 2021… The highest number ever.” More funding was then granted to the NHS in the Budget and subsequently.

The total list in March this year was 3.8 million – up from 3.7 million last year.

Meanwhile, Mr Baumann told the meeting the “holy grail” of provider and commissioner plans matching had not been completely achieved, but the gap in this year’s planning round was “much smaller than we have ever had before”.

He said organisations had “responded directly to the challenge we set on non-elective activity”, planning for “almost exactly” the 2.3 per cent growth which NHSE and I had suggested.

Mr Baumann said 90 per cent of areas had agreed contracts, though there were a “handful of places that have serious issues”, which national officials would be seeking to resolve.

He said 30 organisations’ draft plans did not “deliver the required financial performance” asked of them by NHSE and I. These were in 15 of the “most challenged health economies”, he said, and that the gaps from their financial targets were “pretty big”.

He said: “It is already evident that quite a number of these places some really difficult choices will have to be made [to close the gap between plans]”.

Mr Baumann added that resolving this would be a “very important test of the shared endeavour” of NHS Improvement and NHS England, in particular ensuring the “right difficult choices” are made.

Last year several health economies with large gaps were subject to a “capped expenditure process”, which led to controversy over cuts to services, and about whether these places could or should plan for less elective activity.

NHSI finance director Elizabeth O’Mahony, also speaking about the planning paper, highlighted concerns about the “impact on quality” of “high numbers” in savings plans.

She said clinical managers were working with providers to “understand the ramifications of the saving plans coming through”. She added that “as it stands we are concerned at whether or not the workforce actually exists” to deliver plans.

Ms O’Mahony added that for the first time the NHSI finance team would be writing to acute trust chairs to confirm NHSI had the same understanding of their plans as they did. She said no plan would be signed off without that confirmation.