Last reviewed 3 February 2016
Thoreya Swage, Healthcare Consultant, looks at the Planning Guidance for 2016/17 which sets out proposals for ways to implement the Five Year Forward View, the strategy for the NHS in England for the coming years.
In December 2015, the NHS published Delivering the Forward View: NHS Shared Planning Guidance 2016/17 – 2020/21. One of the key themes of the document was a new focus on a whole-systems approach to improving health and social care in England.
In recognition of this changed approach, this guidance has been developed by six national organisations: NHS England, The National Institute for Health and Care Excellence (NICE), NHS Improvement (Monitor and the NHS Trust Development Authority combined), the Care Quality Commission (CQC), Public Health England (PHE) and Health Education England (HEE).
The guidance supports the implementation of the five-year strategy for the NHS in England, the Five Year Forward View, which was published in 2014. It also identifies three major tasks for the NHS to achieve as highlighted in the Five Year Forward View; to achieve financial sustainability; to improve the quality of care; and to enhance the access to healthcare for patients.
Plans for the future
The document requires the NHS to produce two major plans, one short-term, one medium term, which together outline strategy for the NHS to implement these improvements.
A five-year strategic Sustainability and Transformation Plan (STP) based on the Five Year Forward View.
A one-year Operational Plan for 2016/17 which essentially provides the detail of the first year of the STP.
Last year (2015/16), the Planning Guidance focused on the development of new care models and other initiatives as described in the Five Year Forward View. It has been noted that different parts of the country responded to this at differing rates of development and, as such, for the next year (2016/17), healthcare systems are required to accelerate the rate of change, concentrating on prevention and the redesign of care, including pathways. In order to build up momentum, health and social care systems are asked to identify and implement change in a few priority areas in early 2016.
Planning for populations — “place-based planning”
In the past, planning has traditionally been undertaken by individual organisations with little reference to each other within a health system. This often has not made sense to the patients and the communities that are served by these bodies.
For the first time, emphasis has shifted to planning by place, or “place-based planning”, for local populations rather than solely on planning by individual organisations. The successful implementation of this shift will require leadership within the health system, including:
leaders in a locality working together as a team
sharing a vision with the local community and involving local authorities (LAs), where possible
agreeing a set of activities for implementation
ensuring that the plan is followed and monitored
learning and making adaptations as necessary.
If such leadership is not found as a result of oversight by NHS England, NHS Improvement will be prompted to take action.
As a strategic plan, all activities commissioned by the Clinical Commissioning Groups (CCGs) and NHS England should be covered in the STP. The activities include specialist services (which are led from the ten collaborative commissioning hubs across the country) and primary medical services, whether or not they are delegated to the local CCG. Integrated care with LA services should be included, as well as prevention and social care, as identified in local health and wellbeing strategies.
Funding for transformation
Unlike previous years, central funding (transformational funding) has been made available from 2017/18 onwards to support the local planning and implementation processes. Specific areas have been prioritised and the mechanism for securing such funding will be established through the STP. These areas include the continued development of the new models of care (the Vanguard sites) and related projects, access to primary care and infrastructure, roll-out of key technologies and clinical priorities such as prevention of diabetes, cancer, mental health and learning disabilities.
To support local healthcare systems in developing their STP, the Planning Guidance document lists a set of “national challenges” to guide the process. These challenges comprise a set of questions that have been set in the mandate for NHS England to be considered on a local level. The overall aim of the STP is to create a clear vision and plan for the local healthcare system. In addition, the STP is required to consider three key questions.
How will the health and wellbeing gap be closed?
How will transformation be driven in order to close the care and quality gap?
How will the finance and efficiency gap be closed?
These issues should be examined in further detail, addressing the following key areas.
The health and wellbeing gap.
This includes the plans for a greater focus on prevention (or a “radical upgrade”) and more effective community engagement and patient involvement. Specific areas for consideration by the STP are as follows.
How will health services work with LAs to tackle the most important and highest cost preventable causes of ill health to tackle health inequalities and healthcare demand such as diabetes and obesity, including childhood obesity?
How will patient engagement be harnessed better to reduce demand?
How soon will the area achieve full implementation of the national Diabetes Prevention Programme (DPP)?
What plans are there for patients to have access to the named accountable consultants?
How will integrated personal budgets be expanded to facilitate patient choice?
How is the health and wellbeing of the local workforce being improved, such as through involvement in the Healthy NHS programme?
The care and quality gap.
This section includes plans for the development of new care models, improving clinical outcomes and roll-out of digital healthcare. Areas to be considered are:
ensuring the sustainability of general practice and wider primary care, and supporting infrastructure
the rapid implementation of enhanced access to primary care in the evenings and weekends and through the use of technology
adopting new models of out-of-hospital care, such as Multi-specialty Community Providers (MCPs) or Primary and Acute Care Systems (PACS), and applying good practice identified from the enhanced health in care homes Vanguards
adopting new models of acute care collaboration such as accountable clinical networks, Foundation Trusts and specialty franchises
simplifying the many and confusing points of entry to emergency and urgent care and transforming these services so that A&E and ambulance access standards are achieved and maintained
achieving (if appropriate) and maintaining the referral to treatment standards for routine care
improving cancer care, particularly prevention, diagnosis, treatment and aftercare
improving mental health and dementia services and care for people with learning disabilities
improving quality and safety and ensuring that no trust or practice in the area has an overall “inadequate” rating from the CQC
implementing seven-day services
improving the use of information technology including plans to move to a fully inter-operational health and social care system by 2020
ensuring the workforce is retained and retrained with the right skills, values and behaviours to deliver transformed care.
The finance and efficiency gap
This addresses how financial balance will be achieved across the health system as well as improving the efficiency of NHS services, including consideration of:
how efficiency savings will be achieved
managing demand and reducing costs
better use of capital investments to unlock additional savings.
The guidance states that the first task is to agree the “transformation footprint” — the geographical area that will be covered by the STP — as defined by natural communities, current working relationships and patient flows, and the scale necessary to deliver services and transformation programmes. There also needs to be a best fit with other footprints, such as learning disability planning systems. These footprints may change over time in the interests of simplifying arrangements.
In many cases, the footprint will reflect local systems already working together, for example, the MCPs and PACS Vanguards that have been operating this year. In other less developed areas, discussions will be further behind. However, the key issue is that there is no “correct” answer and the solutions must come from the joint systems themselves.
The Operational Plan for 2016/17
As indicated above, the Operational Plan represents the first year of the STP and therefore marks the beginning of the journey to deliver the Five Year Forward View. In order to achieve this aim, there are nine identified “must dos” for local healthcare systems for 2016/17.
Develop the STP to accelerate progress in towards achieving the three key aims of the Five Year Forward View.
Ensure that the healthcare system returns to an aggregate financial balance (determined by the combined financial position of trusts and foundation trusts).
Develop and implement a plan for the sustainability and quality of local general practices, addressing in particular workforce and workload matters.
Ensure that the access standards for A&E and ambulance waits are back on track (that is, a maximum of a four hour wait in A&E is achieved for more than 95% of patients, and ambulances respond to 75% of Category A calls within eight minutes of receiving the call)
Referral to treatment standard of no more than 18 weeks for routine care is met in more than 92% of patients
Address the 62-day cancer waiting standard, reducing the proportion of cancers diagnosed following emergency admission and demonstrating improvements in 1-year cancer survival rates.
Ensure that there is a diagnosis rate of at least two-thirds in the number of people who are estimated to have dementia and that two new mental health access standards are achieved and maintained. The access standards are:
greater than 50% of people having a first episode of psychosis commence treatment within 2 weeks of referral
75% of people with common mental health conditions are referred within 6 weeks to the Improved Access to Psychological Therapies (IAPT) programme with 95% treated within 18 weeks.
Implement enhanced community provision and a reduction in patient services for people with learning disability in line with published policy.
Develop and implement plans for organisations in special measures to improve quality of care and publish avoidable mortality rates for individual trusts.
Progress on the implementation of the Operational Plan for 2016/17 will be assessed by a new CCG Assessment Framework. This is different from the CCG Assurance Framework published in previous years as this document measures progress across local health and social care systems reflecting the combined approach to planning health and social care. NHS England will be consulting on this new framework in January 2016.
Local health and social care systems are required to have determined their transformational footprint by the end of January 2016 and, at the same time, begin work on the operational plans and STPs. The draft operational plans are to be submitted in about a week later with the final versions due on 11 April.
After submission in June 2016, all STPs will undergo a formal assessment by NHS England and local systems will be notified thereafter if their STP provides a “compelling and credible” case for additional funding, to start in April 2017.