New planning guidance will lock in positive changes during pandemic

At a joint board meeting on 25 June, NHS England and NHS Improvement said the pandemic has led to new ways of working that has been implemented quickly. This had resulted in faster decision-making, wider partnerships, greater use of digital technology and a renewed clinical focus on prevention.

NHS chief executive Simon Stevens (pictured) told the meeting that the health service would keep beneficial developments as it moves to restore services.

But, in the immediate future, discussions at national and local levels would focus on restarting services that had to be suspended during the pandemic. So-called phase three of the NHS response will be set out in early July, he said. It will ask local health systems to detail how they will continue to restore services and deal with health inequalities highlighted by the pandemic.

Currently the health service has declared a stage 4 national incident – this triggers a centrally managed response to a crisis. He hoped this would be relaxed by the end of July, should there be no spikes in coronavirus cases following the removal of restrictions by the government. This would allow the NHS to move towards normal activity levels.

‘We have a massive job on our hands to ensure the health service is there for the range of conditions it is set up to treat, while doing so in a continuing era of the threat of coronavirus,’ he added.’

Chief financial officer Julian Kelly said the initial, temporary financial regime of block contracts, topped up with the additional costs of the Covid response, is due to end on 31 July.

‘We are now at the stage of firming up the proposals for the regime that needs to exist for the second half of the year. We are in discussion with the Department [of Health and Social Care] and across government about what those rules could be and what the funding framework should be for the balance of the year.’

The rules would ensure financial discipline and include incentives to drive the recovery of normal health services. However, they would also reflect Covid-related cost pressures.

A board paper said positive new initiatives developed during the pandemic will be shared and escalated across the service. It set out examples of these innovations, and those that will be expanded as the service moves into the period of restoration. These include:

• Ambulance rates of conveyance of patients to hospital reduced in April and May. The national bodies aim to maintain the May levels by increasing the use of ‘hear and treat’ in control rooms, and ‘see and treat’, where crews support patients to remain at home.
• More than 80% of trusts can now carry out video outpatient consultations and more than 250,000 consultations have been delivered in the year to date in acute, mental health and other outpatient and urgent care services. This exceeds the goal for the full year. The paper said 46% of outpatient services were delivered virtually from the implementation of the NHS Covid response in March and April, compared with 6% in February and part of March, though it should be noted that overall outpatient activity has reduced.

National and regional teams are focusing on supporting all systems to move to integrated care system status by April 2021, a deadline set in the initial operational plan for 2020/21.

Sir Simon confirmed the financial position at the end of 2019/20. ‘I would like to thank trusts and CCGs for the financial discipline shown throughout this last year. We will be laying our combined accounts before Parliament in due course, but, as the audit process comes to a conclusion, once again the NHS balanced its books and, as planned, we halved the number of trusts in deficit.’

Last month he told the Commons Public Accounts Committee that the NHS had broken even in 2019/20, before accounting for the exceptional Covid-19 expenditure at the end of the financial year.

He added: ‘We are also delivering on important commitments such as the mental health investment standard, by which we guarantee that at a national level resources going into mental health services grow faster than those for the NHS overall.’

He wanted the NHS to ‘proactively redesign’ its services. ‘The key challenge in front of us now is to ensure that, as we restart services, we lock in some of the innovative gains we have made during this period, and we use the harsh spotlight the coronavirus has shone on deep-seated health and social inequalities, particularly as they relate to black, Asian and minority ethnic communities.’