If you’re involved in the nitty-gritty of this year’s planning round, here’s what you need to know about the latest planning guidance. By Rob Findlay
Last year the English NHS broke with tradition, and planned ahead for two years instead of one. So we don’t need a planning round this year, do we?
Of course we don’t. But it never hurts to have a little “refresh”, and the guidance has duly rolled out. If you’re one of the lucky people who gets to work on the details, here are some headlines that you won’t want to miss.
“3.2: Plans will also be collected on planned bed numbers to ensure sufficient capacity is available throughout the year to meet anticipated demand for emergency and elective care.
“6.1: include appropriate phasing profiles to reflect seasonal changes in demand, especially related to winter”
Seasonal planning isn’t just about winter emergencies – the competition for beds and staff involves electives too and happens all year round.
So the guidance rightly calls for emergency and elective care to be planned together and profiled through the year. And don’t think you can come back in the autumn for more, because:
“6.18: There will be no additional winter funding in 2018-19. To ensure that winter preparation has been undertaken well in advance and using existing funds, systems will need to demonstrate that winter plans are embedded both in their system plans and in individual organisations’ operating plans, including realistic phasing of non-elective and elective activity across the year.”
So that’s abundantly clear then.
Or rather it isn’t, because in the very next paragraph the guidance goes and spoils it:
“6.19: To support this there is a requirement for each system to produce a separate winter demand and capacity plan… Guidance on submitting these winter plans will be available by March 2018.”
Embedded seasonal planning now, or bolted-on winter planning later? Some habits, it seems, will take a little longer to break.
“3.2: plan and report non-elective admissions of less than one day separately from those of one day or more.
“3.7: plan and report separately on day case and inpatient elective activity”
The NHS usually plans elective day cases separately from elective inpatients anyway, and now the split extends to the non-elective side too – and this new rule alone means that every planning model in England will have to be revised.
This also reinforces that planning is a stage-of-treatment affair, and cannot be done on a referral-to-treatment basis. If elective and non-elective inpatients and day cases are all planned separately, then so are new and follow-up outpatients… all by specialty, all by provider, and profiled through the year.
“5.1: STPs should ensure a system-wide approach to operating plans that aligns key assumptions between providers and commissioners which are credible in the round”
Gone are the days when every provider did planning in its own way – now it is system-wide. Making this work will require cross-Sustainability and Transformation Partnership standardisation of planning approaches and formats, and full collaboration, because no hodge-podge of individually-crafted spreadsheets is ever going to add up properly.
“6.6: All commissioners… and all providers are required to submit a full suite of operating plan returns to the deadlines in the national timetable”
The guidance came out on Friday 2nd February. Draft plans must be submitted by Thursday 8th March – barely five weeks later (including half term). The national deadline for sign-off is Friday 23rd March – only seven weeks after the guidance. And this is in an NHS where it can easily take a month just to arrange a meeting.
If planning were an ongoing quarterly process for the NHS to adapt continuously to unfolding events, then this sort of timetable would be fair enough. Instead it is an annual event that changes every time. So there is a choice to be made between doing it quickly and doing it well.
Which brings us to something else that isn’t mentioned in the guidance.
“3.8: Provider plans will need to consider the capacity required to deliver the growth in non-elective and elective activity and the impact on workforce, finance and productivity.
“6.1: it is now more critical than ever that activity and finance plans are aligned between commissioners and providers”
On the one hand, this is operational planning for the real world. On the other hand, it’s about financial control and the NHS contract. The problem is that those things are counted differently.
“Activity and finance” points towards one data source – activity that commissioners agree to pay for. “Capacity” points towards another – real patients being cared for by real staff, whether commissioners end up paying for them or not.
Those data sources bear some resemblance to one another, but they aren’t close enough to fudge the difference.
So the NHS faces another choice. Plan the real world, or plan the finance.
Clearly the former is better. But in the current climate and time available? I suspect much of the NHS will default to the latter.