Savings drive softened after 'top-down pressure' complaints

In a letter sent to providers in around 14 “capped expenditure” areas today, NHS Improvement said organisations should not be considering plans that would breach patients’ constitutional rights over elective care, and will need to ensure that patient safety and service quality are maintained.

As previously reported by HSJ, some of these areas have considered whether to systematically draw out waiting times for planned care, including explicit consideration of breaching the 18 week waiting standard, and limiting patients’ ability to opt for non-NHS providers. Other options have included cutting staffing levels and closing or downgrading services.

These plans were drawn up in response to instructions sent out in April by NHSI and NHS England, which warned the areas they had been “living off bailouts from other parts of the country” and would now need to take “difficult choices” to stay within a combined funding envelope for their area.

The previous instructions did not state constitutional standards over waiting times and patient choice would need to be maintained.

HSJ understands the capped expenditure process initially aimed to close a financial gap of £470m, which was the distance between the financial plans and targets of providers within the 14 areas. However, proposals drawn up locally indicated potential savings of £250m, with significant concerns about the risks involved in delivering these.

It is understood that national leaders have now agreed to focus on delivering £250m, instead of pushing to get closer to £470m.

Chris Hopson, chief executive of NHS Providers, said: “The trusts involved told us very clearly that they were concerned about the level and speed of savings required, the degree of top-down pressure being put on them and the lack of transparency in the process.

“We shared these concerns and have had a constructive dialogue with NHS England and NHS Improvement. There is recognition that the frontline will not be able to deliver anything like the original level of savings this financial year and that any savings should be fully impact assessed before implementation. We are pleased that legitimate frontline concern has have been heard and acted on.”

NHSI chief executive Jim Mackey said in the letter: “Further to a number of queries in respect of the capped expenditure process and a dialogue with NHS Providers, I am writing to you to clarify the position and to set out NHS Improvement’s expectations…

“Firstly, provider board assurance, on a self-assessment basis, must take place so that the consequences of proposed trust CEP plans are fully considered and will safeguard patient safety and quality.

“Secondly, providers need to ensure that CEP plans are consistent with constitutional rights for RTT (the 18 week referral to treatment standard) and patient choice.

“Thirdly, where CEP service reconfiguration proposals trigger the NHS’ public consultation duties, these will need to be followed. In addition, providers should also ensure that patients and staff are engaged throughout the planning and implementation stages of CEP.”

He said initial submissions will “only be viewed at this stage as proposals”, and NHSI would work with NHS England and the Department of Health to understand the impact of implementation.

Mr Mackey said areas with the largest gap between their planned expenditure for 2017-18 and their budget allocation for the year had been chosen for the CEP, but stressed it is just “one part” of the effort to help areas resolve their financial issues at system level.