New actions for the NHS: what do they mean for us?

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As you may have seen in the news, NHS England (NHSE) and NHS Improvement (NHSI) are taking significant steps to address the financial deficits and improve accountability of all NHS trusts to operate within the financial constraints made available by central government.

Supported by the Department of Health (DH) and the Care Quality Commission (CQC), NHSE and NHSI have developed a set of actions aimed at bringing NHS organisations back in line with the public resources available to fund them.

When NHS providers are fined, these fines do not benefit patients and often penalise organisations for having to operate against rigid performance indicators in the face of ever-increasing demand. So the new plans are to replace fines with incentives linked to contractually-agreed performance improvement trajectories; for EEAST, this would translate into an agreed improvement ‘trajectory’ of performance against Red 1 / Red 2 indicators, taking into account the monthly growth in actual demand on the ambulance service.

We have experienced a rise of 18% more Red 999 calls compared with the same period last year and are working hard with commissioners and NHSE / NHSI to develop not only a new operating model to sustainably manage the year-on-year increase in demand, but also a Remedial Action Plan (RAP) to support short-term service improvements.

The NHSE/NHSI plans also suggest that financial ‘controls’ for both individual trusts and CCGs must also be implemented to ensure services are delivered within the agreed financial measures which their boards, governing bodies and CEOs will be held directly accountable for. Where Trusts and CCGs don’t meet these measures, a set of new Special Measures will be enforced.

Other ‘common sense’ measures include:

  • new controls to cap spend on interim managers in CCGs, designed to use this saving to fund temporary staffing  for providers that do not have a sustainable workforce in place
  • a two-year planning and contracting cycle linked with the sustainability and transformation plans (STP), to establish achievable improvement trajectories e.g. working together with acute hospitals to reduce excessive hospital handover delays, and community service providers to treat patients closer to home where they do not require conveyance to A&E).

As part of the £1.8bn Sustainability and Transformation Fund (STF), the ultimate aim of this overarching plan is to ensure the NHS remains a viable and sustainable service for all, continuing to be free at the point of use.

The only provider in our region to enter financial special measures is the Norfolk and Norwich University Hospitals NHS Foundation Trust (NNUH); however, Bedfordshire CCG has been rated inadequate and has therefore been required to develop and implement a performance improvement plan under legal direction from NHS England.

Clearly the NHS is an extremely challenging place both in terms of increased pressure and activity and limited funding and our business development and contract teams will continue to work closely with the 19 CCGs and the new six STPs in the East of England to agree an operating model that both supports patients and staff.

Published 1st august, 2016

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