Dalton: trusts must be realistic about their 2018/19 plans

In a letter to trusts, Mr Dalton said activity plans, financial plans and performance trajectories did not align. ‘In these cases, there is insufficient read-across between activity plans, financial plans and performance trajectories,’ he said. ‘And capacity and/or workforce assumptions do not look realistic or deliverable, given the current context.’ 

He went on: ‘Given the high levels of occupancy in the system, and the knock-on impact this has on patient experience, performance and system finances, we need to be absolutely clear what can be realistically delivered and where potential capacity and/or performance gaps exist.’

Mr Dalton insisted that highlighting potential problems in a planned and managed way at the start of the year would allow the NHS to agree collective action to address the issues.

‘This is infinitely preferable to submitting a plan where there is no realistic chance of delivery and then watching performance go off plan during the year,’ he said.

The plans were due to be submitted after Healthcare Finance went to press. The oversight body chief paid tribute to the NHS staff involved in the planning round work. He acknowledged that it has been a difficult task, given the pressure the service was under in the first two months of 2018. And the new money allocated in the November Budget necessitated a speedy adjustment in the national planning framework.

Nevertheless, NHS Improvement expected trusts to build plans that are based on effective demand and capacity planning.

The plans should set out, by month:

• Number of beds/amount of capacity open and available
• Activity levels that will be delivered
• Planned financial position
• Performance levels trusts ‘genuinely expect to deliver’, highlighting any gaps against national planning requirements.

In response to the letter, NHS Providers chief executive Chris Hopson said NHS Improvement wanted deliverable plans. ’Our conversations with NHS Improvement indicate that it wants realistic 2018/19 plans that reflect what trusts genuinely believe they can deliver. Not what trusts hope they can deliver, what they would like to deliver, or what the planning guidance says they should deliver.’

He added: ‘NHS Improvement wants to know now, at the start of the year, where the gaps are – be they money, performance or activity levels – so there can be a sensible debate on how to deal with those gaps. The 2018/19 delivery task looks beyond stretching.

‘The letter says it’s better to identify the problems now, than pretend they don’t exist and fall off plan in year. Trusts tell us they have felt under pressure to submit plans “with the right answer”. So how NHS Improvement teams react to the realism that’s being asked for, when they get it, will be key.’