Commenting on the NHS 2018/19 planning guidance released today, Saffron Cordery, director of policy and strategy and deputy chief executive of NHS Providers said:

“Trusts will welcome the clarity on how much can be delivered for the extra money, though we need to recognise that holding performance and meeting the required financial task is at the top end of what can be expected. Trusts will also welcome the extra support in the form of a further £650 million of sustainability funding which now totals £2.45 billion. But we need to recognise, as the National Audit Office argued a fortnight ago, that this means less money for much needed transformation of services for patients.

Trusts will welcome the clarity on how much can be delivered for the extra money, though we need to recognise that holding performance and meeting the required financial task is at the top end of what can be expected.

“We support the expectation for providers and CCGs to plan and contract on the basis of agreed estimates of demand growth, which has often not occurred in the past. We also welcome a specific new mechanism to incentivise commissioners to do all they can to reduce emergency demand. But both of these will require consistent, effective, action by commissioners and a high degree of collaboration between commissioners and providers. Trusts will also be pleased to see the intent to drop nearly all contract fines and penalties, something for which NHS Providers has long argued.

“We welcome the commitment to continue increasing spending on mental health and community services, but will want to ensure this actually reaches the frontline in the form of increased funding and activity commissioned.” 

“Further guidance on how STPs, local system working and the move to integrated care are expected to develop, is helpful. But we would like to see a more formal and extensive engagement and consultation process on the national policy direction, along with more clarity on support for local systems which, for good reason, are finding this transition difficult. To that end, it is helpful to see a commitment to public engagement. We also need realism on how fast the required transformation will occur, given how much less we are investing in change compared to the assumptions made when the Five year forward view was created.

We also need realism on how fast the required transformation will occur, given how much less we are investing in change compared to the assumptions made when the Five year forward view was created.

“We would also urge NHS Improvement to think carefully about whether, how and when it takes formal regulatory action against trusts who refuse to accept their control total. Trust have told us that they are more concerned than ever about their ability to meet their control totals next year. It is of fundamental importance that Trust Boards set their own budgets and have the ability to legitimately reject, and then renegotiate, a control total which they believe is impossible to deliver.

“There are two areas on which the guidance is silent that will need to be resolved at the appropriate point, as they are all areas where providers are likely to need further support and clarity in 2018/19. First, if the sector ends the year further in deficit, as expected, we will need clarity on how the plan will adapted. Second, once we know the details of how the pay cap will end, we will need to understand how providers will be fully reimbursed for any extra cost incurred in 2018/19.

“Trusts will stretch every sinew to deliver what is being asked of them but 2018/19 is shaping up to be just as challenging as the last three years, if not more so. The extra money in the Budget, welcome though it was, has turned an impossible task into an extremely difficult one.  

Trusts will stretch every sinew to deliver what is being asked of them but 2018/19 is shaping up to be just as challenging as the last three years, if not more so.

“We also need to be completely clear about the overall strategic position. We have reached a watershed moment. The NHS is coming through the worst winter in its recent history. This is also the first time that we have had to accept, before the year even starts, that the NHS will not meet its key constitutional standards. We have also had to accept that the NHS will not be able to improve performance against those targets, just hold current performance levels. Even that is challenging. We also have to recognise that in light of the available funding, the focus has to be on sustaining the current service, rather than investment in transformation. It reinforces, yet again, that if we want to provide the right quality of care to a growing, older and frailer population, we need the right long term financial settlement for health and care. Creating that settlement will take time and we simply cannot wait for the next spending review for that work to start.”