Comment / The real thing

US president Dwight Eisenhower is quoted as saying ‘plans are nothing, planning is everything’. He may have been referring to his time leading the US army, but the sentiment holds true for the NHS and the delivery of high-quality, sustainable services.

The NHS is awash with plans and things really come to a head at this time of year. We have already met deadlines to meet two-year operational and financial plans and we should all be well into the preparation for longer term five-year plans.

How often in the past have plans really added value across whole health economies? Many of us will have had experience of health economies where individual organisation plans don’t stack up – for example, planned demand management by a commissioner, implying a reduction in acute capacity, not reflected in the provider’s own plan for the year ahead.

There are always reasons. Providers might point to previous failed attempts to deliver activity reductions as good reason to base their own local plans on their view of a ‘realistic’ assessment of expected activity levels. But this ‘not stacking up’ has consequences – often leading to heroic cost improvement plans.

Now, more than ever, we all need to get onto the same page. We need to see all our plans become fully integrated. Plans within a single organisation need to be aligned – so that human resource plans are consistent with the overarching service strategy and, importantly, with the finance plan. And then we need to see plans aligned across organisations.

The central powers – NHS England, the NHS Trust Development Authority and Monitor – have attempted to align their planning requirements and timetables this year. And they have promised a degree of triangulation to ensure that plans agree both in the short term and the long term.

But we need to ensure we have undertaken our own triangulation process before we get to the assurance stage. So if a commissioner has a strategy to reduce inpatient admissions over the coming years, we need to see that corresponding reduction in capacity clearly in the provider’s plans for the period.

This is where Eisenhower’s distinction between ‘plans’ and ‘planning’ is really important. This service transformation won’t happen because the numbers are written down in a plan. We need to make it happen. It won’t be easy, but nor is it something we can afford to put off for another year.

We need to sit down as whole health economies, with all the relevant professions around the table, and agree what we are going to deliver and how we will collectively make it happen. The plans are then simply a way of capturing this agreed way forward.

Finance has to have a place at the table and, in fact, will need to take a lead role. Finance often provides an important way to translate all plans into a common currency and understand the combined impact. The delivery of high-quality care has to be at the core of everything we do, but we can’t commit to unaffordable, unsustainable services.

If it doesn’t add up, we can’t afford to gloss over it in the mistaken hope that, for example, we can cover the gap with rising activity. We need to be involved at every stage to provide a constant reminder that every clinical decision is a financial decision. And we need to constantly push for the development of services that meet the needs of patients in a sustainable way.

Real planning – across whole health economies and involving all disciplines, not just in silos – is what Eisenhower meant, and that’s what the NHS needs to deliver right now.