Operating Framework 2010/11 – Summary

National priorities

The Operating Framework for the NHS sets out the priorities for the NHS for the year ahead. In 2008/9 five broad national priorities were introduced, which remain the same for 2010/11.

1. Cleanliness and healthcare-associated infections

• There is still variation in rates of MRSA and Clostridium difficile infections, despite overall reductions. Poorer performing organisations are expected to improve significantly in 2010/11.
• For MRSA, infection rates should be reduced to average levels or – for poorer performing organisations – improved by 20 per cent.  A new minimum standard on Clostridium difficile will be introduced in spring 2010.
• Commissioners and providers that have achieved the national 30 per cent reduction in Clostridium difficile should agree ‘stretching’ goals through contracts. Providers should screen all relevant emergency admissions for MRSA; this target should be achieved as soon as possible and definitely by 2011.

2. Access to services

• The target that patients receive consultant-led treatment within 18 weeks from referral by their GP remains. Some specialties are not meeting this target.
• PCTs should ensure that patients are able to access GP services at evenings and weekends.
• A new indicator of public experience of accessing NHS dental services will be introduced from April 2011.

3. Keeping people healthy and reducing health inequalities

• As outlined in NHS 2010-2015, priority is to be given to interventions that prevent the early onset of diseases. The aim is to reduce demand for acute services in all disease areas and to reduce health inequalities.
• More progress is needed to ensure all stroke patients are admitted to stroke units and receive brain scans within one hour of admission.
• PCTs are reminded that they must deliver additional breast and bowel cancer screening for specific age groups in 2010 and meet a radiotherapy access target by the end of 2010.   
• A new strategy provides PCTs with different levers to control tobacco use and aim to generate financial savings.

4. Improving patient experience and staff satisfaction and engagement

• Patient feedback on all services will be available on NHS Choices from December 2010.
• NHS organisations should agree a target for reducing sickness absence over 2010/11 and identify the savings that a reduction in agency staff would bring.

5. Emergency planning

• All NHS organisations and local authorities should review and update their plans for dealing with a ‘flu pandemic and should give high priority to putting in place plans to deal with major incidents such as terrorist attacks, flooding and any impact from climate change.
• PCTs should develop strategies for delivering vaccinations for pandemic ‘flu.

System levers and enablers

A series of levers and enablers are in place to support the delivery of these priorities.

Objectives include: moving care closer to home, reducing the number of acute beds, reducing unit costs and variations, focusing on early intervention and encouraging people to take more responsibility for their health.

Financial framework

2010/11 will be the last year of growth in NHS funding for some time. 

Management of NHS revenue surplus

The surplus that PCTs and SHAs have built up can be brought forward to 2010/11. The SHA and PCT sector as a whole will plan to end 2010/11 with a surplus of £1 billion and SHAs will discuss with the Department of Health how to distribute that surplus in their area. 

PCTs should make 2 per cent of their budget available to be spent on ‘non-recurrent’ items. This is intended to create financial flexibility to support service transformation.  All PCTs will have to meet this requirement (as a minimum) by 2013/14. Where a PCT is unable to meet this requirement, the SHA must ensure the aggregate regional level remains at 2 per cent.

Revenue and capital allocations

The average allocation to PCTs in 2010/11 remains unchanged, with growth of 5.5 per cent.  For the years 2011/12 and 2012/13 allocations will be in line with inflation. 

Capital expenditure will be reduced.

SHA bundle and central allocations

Central budgets for ophthalmic services and pharmacy (£500 million of activity) will be devolved to PCTs (primary dental care has already been devolved). Funding will be allocated at 2009/10 cash levels; funding for growth required for 2010/11 will come from savings made by PCTs as a result of lower tariff prices.

Improvements in financial management

PCTs and NHS trusts are expected to improve their financial management and to produce financial plans for 2010 that are compliant with international financial reporting standards.

Efficiency management

NHS organisations should consider how to reduce back-office costs and get better value from procurement.

Incentives and business rules

From 2010/11 the tariff will be designed to incentivise providers to maximise efficiency and quality and to encourage a shift in care from hospitals to community settings.

• In 2010/11 – and the following three years – there will be a 0 per cent uplift in national tariff prices and also in non-tariff prices where these apply.
• After 2010/11 national tariffs will represent the maximum price payable by a commissioner.
• Best practice tariffs will be introduced for cataracts, cholecystectomy, fragility hip fracture and stroke in 2010/11. They will be assessed for their success in reducing the variation in quality between providers.
• The proportion of contract income available to providers under agreed CQUIN schemes will treble to 1.5 per cent and the schemes must include a patient experience element.
• From 2011/12 PCTs will have the power to withhold a proportion of contract payment, rising to 10 per cent over time, if trusts fail to meet patient satisfaction goals.
• From April 2010 no payment will be made to a provider where treatment results in a ‘never event’ (a potentially avoidable medical error).
• In 2010/11 any emergency activity above a contracted baseline will only be paid for at a rate of 30 per cent of the relevant tariff. Savings will go to SHAs to invest in services that reduce emergency admissions.
• A new currency (unit of care for which providers are funded) for adult mental health services will be made available in 2010/11; a currency for community services is being developed.
• SHAs will have powers to temporarily suspend contractual arrangements between PCTs and providers ‘where those arrangements are demonstrably not in the interests of their patients’.
• The Department of Health will explore the development of tariffs for patient pathways and ‘year of care’.

Workforce

A balance will be needed between workforce flexibility, pay increases, increased productivity and flexibility of employment. Consultants and very senior managers will receive no pay increase for 2010/11 and GP practices will be expected to make at least 1 per cent cash-releasing efficiency savings. Every SHA must reduce management and agency costs by 30 per cent in aggregate by 2013/14.  All NHS organisations must review, and where possible reduce, the number of postgraduate medical specialist training posts and pre-registration commissions for nursing, allied health professionals and health care scientists.

Commissioning and system reform

Commissioners are key to improving quality and efficiency in services and to moving care out of hospitals and into the community.

Changes to contracting arrangements include new contract models to reward the provision of integrated care, to be developed for 2011/12.  PCTs will be expected to achieve at a higher level against the world class commissioning (WCC) assurance process.

The process of assessing and approving mergers, acquisitions and joint ventures will be ‘simplified and accelerated’. All acute and mental health trust boards are expected to become foundation trusts by the end of 2013/14. All PCTs will have to agree plans for the future of their PCT-provided community services by March 2010.

Planning

The framework says ‘we need to have a single view on what ‘excellent’ looks like’ and reminds the NHS that the priorities and principles laid out in the Operating Framework underpin performance monitoring by the CQC and Monitor, as well as the Department of  Health’s world class commissioning programme and NHS Performance Framework. PCTs need to draw up an operational plan for 2010/11.  ‘For absolute clarity’ the Department of Health will review the plans for 2010/11 with each of the ten SHAs by the end of March 2010.