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The long-term plan outlines a lengthy and ambitious agenda of service transformation and system overhaul to make the NHS sustainable.

This includes a major shift away from hospital-based care, ushering in integration to replace competition, and a whole raft of legislative changes to help it all happen.

But to have any chance of making meaningful progress, there must be an escape from its now-routine financial troubles.

The 2018-19 financial year has been another year of failing to deliver on commitments which should never have been made.

Shortly after Ian Dalton took charge of NHS Improvement, the regulator said the provider sector would deliver financial balance, with the help of £600m additional sustainability funding. But as many predicted, the deficit is again set to end up between around £600m and £1bn, which must partly explain his earlier than expected departure.

The notion that clinical commissioning groups would deliver combined financial balance (with a new £400m sustainability fund) has also been proven overly optimistic.

CCGs were forecasting an overspend of £160m at month 10, which could easily climb higher in the final two months.

This means resources that were intended for investment in transformation, or in long-neglected services which could help prevent future activity, have again had to be held back to help offset the deficits.

There wasn’t supposed to be a risk reserve in place in 2018-19, but NHS England’s “other central budgets” (as labelled in the finance reports) have served the same purpose.

They are now forecast to be underspent by £329m, which is money that could have been used more strategically.

Small but symbolic underspends are also forecast for budgets which are perennially underspent: £25m in public health; £30m in primary care and dental; and £6m in health and justice. Specialised budgets are expected to be £90m underspent.

The total commissioning/NHS England surplus is now forecast to be £440m, which is not enough to offset the provider sector. This is why the Department of Health and Social Care has been given an additional in-year bung from the Treasury to avoid breaching its spending limit.

All of this has been routine fare for the last few years, and means the NHS will be starting the next five-year period playing catch-up.

Clearly there is more money coming on stream in 2019-20, and quite a lot of it. This means the financial targets and control totals handed down to local organisations should be far more realistic and achievable.

If those targets are routinely met or exceeded, it will mean that more of the new money is gradually freed up for transformation and preventative services. If they are not (which will happen if financial grip has been well and truly lost), the NHS faces another five years of firefighting, with crucial investment funding held back.