News / NHS targets earned autonomy for systems (Convergence 2017)

Mr Alexander (pictured) said that much of what the NHS had done to improve performance and finances had involved short-term measures, but a long term solution involving earned autonomy would be important for the future. 'We need some coproduction on what this means,' he said.

He suggested that foundation trust principles of localism, autonomy and innovation would be the starting point, but that the context – and particularly the financial context – had changed. 'There has to be a system dynamic as well as an organisational one,' he said.

He praised the service for its work in 2016/17. Providers' deficit in 2016/17 at £791m was a major improvement on the deficit in 2015/16, albeit supported by £1.8bn of sustainability and transformation funding. The target for 2017/18 is a further improvement to an aggregate deficit of £496m, although this relies on the delivery of a higher level of financial efficiencies – 4.3% compared to 3.7% in 2016/17.

Mr Alexander admitted that 2017/18 would also feel like 'another year of capital constraint' with providers' capital plans exceeding the Department of Health's budget and backlog maintenance requirements building up.

Reducing delayed transfers of care will be key to delivering the efficiency programmes. But more generally, Mr Alexander said the NHS, supported by the centre, needed to push on with improving operational productivity, tackling unwarranted variation in clinical activities and support services.

Mr Alexander said he wanted to see some of the opportunities highlighted by programmes such as Getting it right first time – translated into 'actual targets and plans'. He said that tools like the Model Hospital should play a key role in helping organisations target areas for improvement and identify good practice.

He added behaviours would be key to continued improvement. 'We need to make sure we have no wild pendulum swings,' he said, stressing that financial targets should not be delivered at the expense of quality or patient experience. He also underlined the importance of transparent and robust data to underpin strong decision making and urged health economies to develop a 'common understanding of the system position'.