While early publication of the planning guidance is helpful, there is much to be done about meeting expectations and fulfilling demands with stretched resources, writes Tim Gardner

Christmas seems to start earlier every year. Department stores start selling decorations in August, mince pies appearing in supermarkets in September and some US-based radio stations apparently start playing Christmas music in October.

The festive mood now seems to have spread to NHS England and NHS Improvement: the annual health service planning guidance typically emerges in December, so last week’s joint publication of guidance for 2017-18 and 2018-19 was three months early. That must constitute some sort of record.

The guidance includes a few early Christmas presents for the NHS. That includes promises of a newly streamlined and simplified process and a two year planning and contracting round for greater local stability.

There are also, much trumpeted, incentives for mental health in the form of new Commissioning for Quality and Innovations, which undoubtedly reflect considerable work behind the scenes.

The new measures should focus more efforts on improving liaison and community services, even if CQUIN as a general policy lever doesn’t seem to have had as much impact on quality as originally intended.

The guidance includes a few early Christmas presents for the NHS. That includes promises of a newly streamlined and simplified process and a two year planning and contracting round for greater local stability

Plus, there’s no change to the line-up of nine national “must dos” – including the priorities on primary care; urgent and emergency care; elective care; cancer; mental health; learning disabilities; and improving quality – that were set out last year.

Well, sort of. The headings are the same, but the description of what it means to deliver on them has expanded somewhat. My quick and (very) dirty word count suggests the latest description of the ”must dos, at almost 1,200 words”, is almost three times longer than the old one, at just over 400 words.

Some of that reflects progress and various other changes made since last year, and so are entirely logical. But there are also a few new requirements, such as preparing for the new four-hour mental health waiting time target for people in crisis.

And, in other cases, some of the “must dos” do seem to have become just that bit more prescriptive.

Delivering change

Elsewhere, the guidance majors on the importance of sustainability and transformation plans (STPs), with particular emphasis on the need for local systems to work systematically around people rather than organisational boundaries.

It rightly stresses the importance of changing behaviours and building better relationships, both within the health service and beyond it to local government, the third sector – important, but too often overlooked – and other local partners.

Early publication of the planning guidance is helpful, but the deadline for agreeing contracts has also been brought forward and so there’s little respite there

Behaviour and relationships are much more significant factors in successfully achieving change than structures and processes this recognition by the centre is helpful, but writing it into the planning guidance is, of course, the relatively easy bit.

Actually making it happen will take a substantial amount of time and effort locally, and the parts of the country that have had more continuity in terms of people, organisations and boundaries arguably start from a much better place than others.

The same goes for the aspiration to create new relationships with patients and communities – briefly mentioned, but with little elaboration about new support or guidance to help localities make it happen – as well as delivering effective public engagement.

A lack of the latter arguably sparked a large degree of suspicion around the STP process regardless of whether those concerns are actually justified by reality.

Having a two year period for plans and contracts may help local NHS bodies deliver on some of this. Like many of the best things in life – fine wine, cheese, even a famous brand of yeast extract – local relationships need time to develop and mature.

If there’s a basis for concluding that the NHS’s 2020 to do list has been made considerably easier, I haven’t seen it yet.

The guidance aims to provide the tools needed to ‘plan for the years ahead’ – it doesn’t include everything that would have been on NHS organisations’ Christmas lists, but there are certainly a few early presents.

Like many of the best things in life – fine wine, cheese, even a famous brand of yeast extract – local relationships need time to develop and mature

Early publication of the planning guidance is helpful, but the deadline for agreeing contracts has also been brought forward and so there’s little respite there.

But nor does the task seem to have been made substantially more difficult. Expectations were already high. As the planning guidance acknowledges, meeting competing demands within increasingly stretched resources is already difficult and it won’t get easier anytime soon.

The planning process – like Christmas – may have started earlier, but there’s still just as much to get done.

Tim Gardner is senior policy fellow at the Health Foundation