Chiefly, the Guidance:
Positions the Spending Review as a credible basis to accomplish three ‘essential’ tasks:
Implement the Five Year Forward View
Restore and maintain financial balance
Deliver core access and quality standards
NHS to produce two separate but connected plans to an ambitious timetable in the context:
Five Year Sustainability and Transformation Plan (STP)
One year Operational Plan for 16/17 (Year one of the STP)
The Guidance acknowledges that NHS Systems will only be sustainable if they accelerate work on prevention and system redesign. It places an emphasis on system leadership, requiring all components in the system to come together for planning purposes (local communities and Local Government as well as NHS) and states that ‘where collaborative and capable leadership can’t be found NHS England and NHS Improvement will need help to secure remedies through more joined-up and effective system oversight’.
The Guidance highlights additional ‘dedicated’ funding streams for the spread of new care models beyond Vanguards and to drive clinical priorities such as prevention, cancer and mental health. The most compelling and credible STPs will secure earliest additional funding from April 2017 onwards. Note paragraph 13(i) for the characteristics of the best STPs. The annex to the guidance asks a series of questions to frame the planning process, a list of ‘National Challenges’ which is not exclusive.
Systems are asked to define their local footprint for planning purposes by 29 January 2016. Detailed mapping Guidance has been produced to supplement this process. The Guidance notes that where geographies are already involved in the Success Regime or Devolution bids, these would be expected to determine the transformation footprint.
The Guidance defines National ‘Must Dos’ for 2016/17, and nine ‘Must Dos’ for every local system (paragraph 23). The National ‘Must Dos’ include increasing levels of consultant cover and diagnostic services available in hospitals at weekends and references improvements to out of hours care (which may impact diagnostics). The nine local ‘Must Dos’ include: returning to aggregate financial balance, addressing sustainability and quality of general practice, addressing access standards for A&E and ambulance waits, delivering the 62 day cancer waiting standard ‘including by securing adequate diagnostic capacity’, continuing to meet a dementia diagnosis rate of 66.6% of those estimated to have the illness and planning for tangible improvements in quality.
New models of care are expected to feature prominently in STPs. There is a wish to trial in particular mental health initiatives and ‘the reinvention of the acute medical model in small DGHs’. The guidance signals (paragraph 30) a willingness to support CCGs grouping to implement more ‘accelerated cross area pace of change policy by mutual agreement’. Trusts are advised (paragraph 35) to focus on costs not income growth. Paragraph 36 places emphasis on the better management of capital investments, referencing better procurement and alternative methods of securing assets eg MES.
Annex 1 asks:
How will you close the health and wellbeing gap?
See in particular references to patient activation and self care (A1).
How will you drive transformation to close the care and quality gap?
See in particular references to adoption of new models of care (B4), waiting times, patient choice and provider efficiencies (B6), and transformation in cancer prevention and diagnosis (B7), improvement in dementia services (B9), 7 day services (B14), digital road map (B17), improvements to commissioning including in devolved plan areas (B19), innovation (B20).
How will you close the finance and efficiency gap?
See in particular reference to capital investments.
Annex 2 summarises the Government’s Mandate, notably:
- CCG performance scorecard mechanism (1.1)
- 2020 goal of 7 day services (2.1), improvements to patient choice, with a 16/17 plan for milestones to that goal (2.2)
- Definitive cancer diagnostics including measurable progress in 16/17 towards national 6 week standard and agree trajectory for increase in diagnostic capacity required to 2020 (2.3)
- 16/17 goals in dementia planning and post diagnosis treatment and support (4.2)
- New models of care for c20% of population to provide enhanced GP services (6.1)
- Health and social care integration goals including 16/17 goals for supporting local devolution deals (6.2)
- Research and growth goals (7.1 and 7.2)
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