• Every health economy to get “system control total”, made up of those given to individual organisations
  • The most “advanced” areas will have “sustainability funding” linked to the system target
  • Details of the new financial regime for NHS trusts will not be published until January
  • Document confirms changes to CCG allocations, but does not provide detail

Every health economy must produce a “system operating plan” and will be set a shared financial “control total” for 2019-20.

Control totals will be given to every sustainability and transformation partnership and integrated care system, and will simply be the sum of those given to individual organisations, with some flexibility to make “net neutral” changes to the latter.

The measures are outlined in planning guidance published by NHS England and NHS Improvement today. Policies about the new financial regime for NHS trusts, as well as detailed CCG allocations, will not now be publicly announced until January.

System control totals represent a significant shift away from the organisational autonomy which has been built into NHS structures over the last two decades. But the extent of the shift will be limited by the continuing statutory requirements of individual organisations.

Therefore, national leaders have stopped short of making “sustainability fund” payments (from the provider or commissioner sustainability funds) contingent on hitting the new system control totals, except for ICS and potentially for some STPs which apply to take this step.

Several ICS areas already already operate with control totals partly linked to sustainability monies, and all ICSs will be expected to next year.

The document adds: “STPs will also be allowed to do this if all parties agree to manage their finances in this way. This will be an important marker of system maturity and readiness to develop as an ICS.”

Organisations within each health economy will have to take “collective responsibility for the delivery of their system operating plan”, which will set out underlying activity assumptions, capacity, efficiency and workforce plans, transformation objectives, risks to delivery and mitigations.

The document emphasises the need for system data aggregation, showing how all organisations’ plans match up. It says: “Our joint regional teams will have a key role in ensuring local accountability and will work in partnership with system leaders to jointly review draft and final system operating plan overviews and aggregate submissions, including the alignment of provider and commissioner plans.”

The NHS standard contract for 2019-20, also published for consultation on Friday, proposes new requirements “which relate to the integration and co-ordination of care across different providers, by including a new requirement on both commissioner and provider to contribute towards implementation of any relevant local system operating plan”. This will give ”contractual force” to commitments in the system plan, according to the proposals.

Meanwhile, the planning guidance document also confirms there will be an efficiency factor of 1.1 per cent within the national payment tariff, which is around half the current requirement. The proposed tariff cost uplift is 3.8 per cent. 

Detail on key policies held back to January

The planning guidance document did not provide detail on some of the measures that were outlined to local leaders earlier this week, such as changes to commissioning allocations or the new “restructuring fund” to help the most financially challenged areas.

These policies are instead now scheduled to be announced in January, along with indicative commissioning allocations.

On the changes to allocations, the document confirmed there will be new weightings to account for community, mental health and learning disability services need. It also said the new formulas will also be “more responsive to extremes of health inequalities and unmet need”, which is expected to benefit areas with high levels of deprivation.

HSJ was told that the allocation rule changes included removing a current cap on the adjustment which is made for deprivation.