HFMA 2018: Dalton sets out NHS plan expectations

06 December 2018

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Mr Dalton (pictured) told the HFMA annual conference that, to some extent, financial and operational pressures, with workforce issues, were the story of the last few years in the NHS. But he added: ‘It is fair to say that story must change over the next five years. We have a revenue settlement of 3.4% real and that gives us certainty and the knowledge to plan. In return for that certainty and extra investment, which is a real step up from the last five years, the government has set us a number of tests in return.’dalto l

These tests included the elimination of the provider deficit; improvement of productivity and efficiency; the reduction in unwarranted variation; and the management of demand.

The long-term plan would address areas where the NHS must get better, including the provision of outpatients, early diagnosis of cancer and the care of elderly patients. But, alongside the vision for clinical improvement, there would be a plan that works from a financial perspective, addresses workforce issues and would be ‘supportable’ in terms of capacity.

The new financial architecture would begin to form in 2019/20, with a significant amount of the £2.45bn provider sustainability fund transferred into tariffs, particularly to reflect the rising costs of providing urgent and emergency care. There would also be a move away from payment by results in urgent and emergency care to a blended system. Control totals would be ‘achievable, but stretching’.

‘It will be the first year for the sort of NHS financial system we will see over the next five years. Over the longer term we will see the elimination of the deficit in the provider sector as a whole and we need to see a progression towards that.’

Providers will need to deliver efficiencies of at least 1.1% a year, which, again, he referred to as ‘stretching, but achievable’.

Recruitment and retention would be key elements of the plan. Mr Dalton said the NHS needed to do ‘an awful lot of work’ to ensure it had the staff to deliver services to patients. As well as retaining current staff and training new workers, an international recruitment at scale would be needed.

While accountability at organisational level would remain, system-wide working would be required. ‘This is not going to be optional,’ he warned.

System-level strategic plans would be required by next summer. ‘These have to make sense, but we have to be honest about where we are starting from, the capacity of the system and the efficiencies we can drive. We want it to be stretching but real and believable.

‘We want plans that add up and the first building block of that is plans from commissioners and providers that align. I know you have made progress on that, but I would suggest there’s still a way to go.’