• Plans submitted by some trusts are “not sufficiently robust”, says Ian Dalton
  • Further work needed to address issues before final submissions on 30 April
  • Email says there is “insufficient read-across between activity plans, financial plans and performance trajectories”

NHS Improvement has told providers their activity, workforce and financial plans for the new financial year “do not look realistic or achievable”.

In an email to the sector this afternoon, NHSI chief executive Ian Dalton said plans submitted by some trusts are “not sufficiently robust” and further work is needed to address several issues before final submissions are made by 30 April.

Ian Dalton

Ian Dalton said some trusts’ plans ‘need further work’

He said: “From my discussions over the last week, I am concerned that some trust 2018-19 plans are not sufficiently robust and need further work.

“In these cases, there is insufficient read-across between activity plans, financial plans and performance trajectories, and capacity and/or workforce assumptions do not look realistic or deliverable, given the current context.

“Given the high levels of occupancy in the system, and the knock-on impact this has on patient experience, performance and system finances, we need to be absolutely clear what can be realistically delivered and where potential capacity and/or performance gaps exist.”

He said each trust should set out bed numbers, capacity, planned activity, planned financial position and “genuinely” anticipated performance levels for each month.

The email has only been sent to the trust sector so has not been signed by NHS England.

Joint planning guidance published in February by NHSI and NHSE said trusts are required to deliver a combined breakeven position in 2018-19, after accounting for new money announced in the budget and released by the Department of Health and Social Care.

It also said they should plan for a “step change in elective activity” while keeping workforce plans “affordable” and within their ceiling for agency spending.

Mr Dalton added: “Highlighting any potential problems in a planned and managed way at the start of the year means we can then agree what we will collectively do to address them. This is infinitely preferable to submitting a plan where there is no realistic chance of delivery and then watching performance go off plan during the year.”

Chris Hopson, chief executive of NHS Providers, which represents trusts, said NHSI’s reaction to the requested realism “will be key”. He added: “Our conversations with NHS Improvement indicate that they want realistic 2018/19 plans that reflect what trusts genuinely believe they can deliver. Not what trusts hope they can deliver, what they would like to deliver, or what the planning guidance says they should deliver.

“NHSI wants to know now, at the start of the year, where the gaps are - be they money, performance, or activity levels - so there can be a sensible debate on how to deal with those gaps. The 2018/19 delivery task looks beyond stretching. The letter says it’s better to identify the problems now, than pretend they don’t exist and fall off plan in year.

“Trusts tell us they have felt under pressure to submit plans ‘with the right answer’ so how NHSI teams react to the realism that’s being asked for, when they get it, will be key”.