HFMA 2021: Kelly urges winter capacity action

At the HFMA annual conference Mr Kelly (pictured) said the NHS needed greater capacity this winter and beyond.

This winter held many uncertainties. ‘We don't know what’s going to happen, but remaining flexible, prepared to respond, to change plans at short notice, and to flex resources is going to be as critical as it was last year.’

He added that the NHS has risen to the challenge in the last two years, making sure it was not a Covid-only service, and was close to recovering activity to pre-pandemic levels.

‘We are now asking ourselves to step up again – to rise to the challenge. But we can go into it with some confidence, though not underestimating the pressures we face.’

Acute trusts know the importance of reducing ambulance handover delays. One way of achieving this is to increase the flow of patients through the hospital. More bed capacity was needed, but finance directors could be looking at other ways of increasing capacity by taking a more flexible approach.

‘Some of this will be down to social care, but is there more that you can do? In agreement with your local authority, you can set up care hotels, as in the first wave of the pandemic. 

‘There are trusts agreeing funding with the voluntary sector and local authorities to get people back to their homes. Or if it’s difficult to get a care package, they are getting them into a care home.’

He acknowledged that some of these measures would have ongoing costs beyond this financial year.

‘If there are things you can do, get on with it – and talk to my regional teams about the cost of that. If there are sensible things to do with cost consequences [beyond this winter], flag it, and we will deal with it.

‘Pull every lever you can. I am giving you licence to act here today.’

He urged trusts to ‘go further’ on the hospital at home models, and he would ‘make sure of the funding to see that through to next year’.

The NHS in England will receive further funding increases in 2022/23 – a total of nearly £152bn or £9bn more than in the long-term plan settlement. The service had to begin planning to deal with this, including going back to making efficiencies and service change. There were massive opportunities, he insisted, including as a result of the investment in primary care and new service requirements in the GP contract. Investment in Health Education England, which is due to merge with NHS England, will rise next year, to ensure staff are coming through the pipeline.

However, for the acute sector, funding ‘will feel more like flat cash’ next year, he said, with Covid funding set at £2.5bn, compared with the £5bn trusts are saying they are spending this year.

Trusts should be planning how new infection prevention and control rules will affect them. Capital funding had been allocated to help providers with this, and he acknowledged the ‘people who worked incredibly hard and incredibly quickly’ to short deadlines to bring forward schemes for this investment.

He hoped to announce multi-year capital funding, though in the first instance the planning guidance will have a one-year revenue settlement. The financial framework will provide funding for depreciation, he added.

The new financial year will mark a move away from the current financial regime.

‘We need to break out of the emergency funding regime we have been running for the last two years, and get back to system ownership of the payment flows as opposed to the national block we have in place now,’ Mr Kelly said. ‘There is some spadework to do to make sure we have some of the flows of funding in the right place. This is why at this point revenue allocations will be for one year rather than three.’

The aligned payment and incentives approach will be introduced and some volume element is expected in the payment mechanism.

He concluded by saying he did not underestimate the scale of the pressure the NHS will face this winter. ‘I would like to think it’s going to get easier, but it’s going to be tough. But keep giving us your feedback and your questions, and we will try to help where we can, including by making some processes easier than they have been.’