1/15 Important new NHS 20/21 planning guidance issued today. What to make of it if you’re a senior NHS provider sector leader? My new fifteen tweet thread below. Overwhelming impression is of an NHS in a big and important period of transition.
2/15 Today’s planning guidance shows NHS transition. FROM overwhelming focus on single institutions, particularly hospitals, treating illness TO integrated systems with a much greater focus on prevention and wellbeing. Long journey to go on here, but shape increasingly clear.
3/15 We’ll all struggle with “loss of clarity and simple priorities” in moving away from traditional, long established, narrow, acute hospital focussed, basket of priorities/measures. But Long Term Plan right to move to much broader vision & definition of NHS success….
4/15 Key strength of NHS long term plan is importance placed on mental health and integrating community, primary and social care to provider better care for older people alongside acute hospital care. Reflected-ish in today’s planning guidance.
5/15 Interesting juxtaposition in today’s planning guidance .... between much needed commitment to adding urgent and emergency care acute hospital capacity (we’ve pushed for this for some time) .... with commitment to moving care closer to home where appropriate.
6/15 Planning guidance shows it’ll, rightly, take time to develop wider set of new priorities and the matching new measurement / accountability framework. That’s fine but we’ll all need to manage the resulting ambiguity in the meantime, doing best for patients.
7/15 Planning guidance sits in broader context. Will be best viewed alongside final People Plan, LTP implementation plan, 2020/21 capital settlement, and NHS operating model. This will give us full “new” strategic framework by Summer 2020.
8/15 In meantime, feels important to make 2020/21 feel more like “first full year of the new” not “last year of the old”. Looking forward, not back. EG What’s best way to make this year 1 of agreed STP/ICS plan, not roll over last year’s trust operational plan?
9/15 We all like clear, boiled down, priorities. EG Acute CEOs said they appreciated clarity of “hit A&E, RTT and cancer targets; get a good CQC rating and make sure you’re in financial surplus” [when this was actually deliverable]. The world is rightly more complex now but……
10/15 My eight priority summary would be: TO TRANSFORM AND IMPROVE: 1. develop local system working including Primary Care Networks; 2. Use People Plan to address workforce challenges including recruiting more nurses and making NHS great place to work…
11/15 TO TRANSFORM AND IMPROVE 3. start creating, at pace, key planks of integrated care eg new older people’s pathway; 4. Assess what extra urgent care capacity is needed including right sizing Emergency Departments; 5. Credible efficiency plan including outpatient reform...
12/15 ON “DAY TO DAY” PERFORMANCE: 6. deliver 20/21 commitments on mental health and cancer; 7. hit individual and system financial recovery trajectories; 8. hold/ideally improve A&E and RTT performance. Know this is not whole waterfront but……
13/15 Given current context – rapidly rising demand, big workforce challenges, deteriorating performance and a very tired workforce – the total ask in today’s planning guidance feels very stretching. Not impossible, but very stretching. We need to be realistic!
14/15 Still a huge amount to clarify where local system working really is going. What is the purpose of ICSs? And how will lines of accountability and the role of individual organisations actually work? What does collective management of system performance actually mean?
15/15 Still think there’s a huge advantage to getting planning guidance out early – we did that in September (I think) one year. Would be good to get back to that for 2021/22. Stretching to do what’s needed on this timescale - planning guidance out at end January.
16/15 Important point of detail in today’s planning guidance....proposed solution to reimburse community service providers for costs of agenda for change pay rises for staff working on local authority contracts is flawed. We will need to come back to this quickly...again.
