Early pointers emerge to spell out long-term plan

NHS England said that, as part of developing the plan, it would seek to reduce activity in 17 clinical interventions. While the main goals were to avoid needless harm to patients and free up clinical time, the restrictions will release resources – potentially £200m a year – to be reinvested in patient care, NHS England said.

The interventions, which are not being banned outright, were split into two groups.

Four interventions in category 1 should no longer be commissioned by clinical commissioning groups, except where an individual funding request (IFR) is made. The procedures are deemed inappropriate in most cases or superseded by a safer alternative. They include injections for lower back pain without sciatica and surgery for snoring.

The 13 interventions in category 2 should only be commissioned or performed when specific clinical criteria are met, including varicose vein surgery, tonsillectomy and removal of benign skin lesions.

Subject to the 2019/20 national tariff consultation, commissioners will be allowed to withhold payment for the category 1 interventions if there is no evidence of an IFR. The NHS standard contract for 2019/20 has been amended to require commissioners and providers to comply with the policy.

NHS England medical director Stephen Powis told the organisation’s board meeting on 28 November: ‘Though the financial and contractual changes will start from April 2019, our expectation is that commissioners, providers and clinicians will start to implement the clinical criteria from today. We want to ensure that patients have access to the most appropriate interventions as possible and to minimise avoidable harm as rapidly as possible.’

The 17 interventions were provided a total of 335,000 times as inpatient spells and day cases in 2017/18. NHS England intends to reduce these by at least 128,000 by the end of 2019/20.

It will also consider including a new progress indicator on reduction of the activity in the 2019/20 assessment frameworks for CCGs, sustainability and transformation partnerships and integrated care partnerships.

A series of announcements from prime minister Theresa May (pictured) and her ministers gave further insight into the long-term plan. They allocated at least £2bn of extra funding to mental health and £3.5bn to out-of-hospital services and said funding should be shifted to public health – all important elements of the long-term plan.

Mrs May said the £3.5bn for primary and community health services in England would be used to establish 24/7 community-based rapid response teams, providing emergency as well as day-to-day care, and dedicated support for care home residents.

The money is part of the £20.5bn rise in revenue allocations promised to the NHS over the next five years.

Mrs May said: ‘Many of us might assume that hospital is the safest place to be, but many patients would be much better off being cared for in the community. The longer a patient stays in hospital, the more it costs the NHS and the more pressure is put on its hardworking staff. This needs to change.’