News / NHS ups efficiency stakes with mandatory plan

The NHS in England has been handed a mandatory 10-point efficiency plan, while emerging accountable care systems (ACS) have been offered the prospect of a one-stop shop regulatory regime with NHS England and NHS Improvement.

The plans were set out in the NHS forward view delivery plan, Next steps on the NHS five-year forward view, published at the end of March. As well as the streamlined regulatory regime, an ACS could receive a devolved transformation funding package in 2018, potentially including national funding for the GP forward view, mental health and cancer services. It listed nine potential candidates to become an ACS.

The document sets out goals for the next two years, recognising there must be trade-offs to maintain financial balance. The national service priorities for 2017/18 are on A&E performance (see page 5), better access to GP services and improving cancer and mental health services. However, the plan accepts that ‘some providers’ waiting times will grow’.

Sustainability and transformation plans (STPs) are being updated to reflect national priorities, but the plan said significant risks to delivery remain – on bed occupancy reductions required, workforce supply, capital requirements and residual financial gaps. An STP update that will include final agreed control totals and plans for 2017/18 will be published in the first quarter.

The plan highlighted three NHS truths:

• It is one of the most efficient healthcare systems in the industrialised world
• Health spending is likely to rise significantly over the coming decades because of growing demographic pressures, rising demand and technology advances
• However, substantial opportunities to cut waste and increase efficiency remained.

To deliver these savings, the plan set out a 10-point list of mandatory actions (see box) that aims to save £1bn in 2017/18, with further savings in running costs and reimbursement for the care of overseas patients. NHS England and NHS Improvement will oversee their delivery. 

In 2017/18 they include a £100m cut in back-office costs through consolidation; £350m in procurement savings; almost £380m through medicines efficiencies; £130m in diagnostics; and £100m in estates. 

NHS England chief executive Simon Stevens(above right) acknowledged the pressure on the service, but said the plan set out practical steps to improve care. While it outlined significant progress, including cutting waste, particularly in agency staffing bills, he added: ‘It also, however, frankly sets out where progress has not been as quick, with rising pressure on A&E and acute wards partly caused by delayed transfers of care.’

The document highlighted improved financial grip, including commissioners contributing a planned £800m underspend in 2016/17 to balance overspends in other parts of the NHS. 

NHS England chief financial officer Paul Baumann said CCG forecasts increasingly showed the impact of savings required. At month 11, commissioners forecast a year-end underspend of £0.5m, but CCGs predicted ending the year with a £550m overspend – at month nine the forecast was £370m. 

This will be offset by underspends in direct commissioning and NHS England expenditure. While 79 CCGs were forecasting a year-end overspend, 37 were unplanned.