Bob Alexander: Planning for 2016 /17 and beyond - all in it together?

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  • Posted:Tuesday 22 March 2016

Bob Alexander, Executive Director of Resources/Deputy CEO NHS Improvement, discusses how NHS Improvement will support providers to meet the challenges set out in the NHS shared planning guidance.

This presentation was recorded at our breakfast event on 22 March 2016.


Context, I can't believe there's anybody on this room that doesn’t recognise the context in which we currently find ourselves, at least on the provider side of the service. Month nine providers demonstrating deficit of just under 2.3 billion, 179 providers with an in year deficit, 156 providers forecasting one and the thermometer of service A&E, urgent care, less than 91% in aggregate at Q3. So take that as the backdrop, under any circumstances we would say this is a significant challenge for the service and the provider side particularly.

So what do we hope to achieve in the approach to planning, so effectively there's two components, isn’t there? There's the 16/17 year where we are nationally attempting to have 16/17 as a firebreak year to enable the majority of those providers in financial difficulty this year to have a real opportunity to start to rebalance their positions. Inevitably we will get caught up on the do you need to compromise quality to rebalance the financial position, the response, of course, to that is no and it never has been. What we do need to do is recalibrate and allow people to have the confidence to exercise local judgement in how they discharge service appropriately and live within the resources available and the way in which the 16/17 framework operates, I hope, is to give a number of organisations a better opportunity to do that.  As we then go into the medium term planning process, the sustainability and transformation plans.

If I say a little bit about those, others may comment, these are bottom up strategic plans for patches, footprints, geographies, call them whatever you will, there is a great temptation when you’re in national body, I have to say I have fallen into the trap myself of telling people what their planning footprint should be. I don’t believe we’ve done that in this instance, what we have done though and what we will be doing through the process of evaluation is asking people to justify and assure why that footprint is the most appropriate one for the populations that they’ve identified. And we have 44 of those and I don’t know if Anne might be able to say a little bit more about that piece later on.

The key piece in that, of course, is local governance, local leadership stepping up, occasionally we will support that local leadership where we think some support might be helpful in getting that footprint to the best place it possibly can. And the key ask in those STPs, of course, is to articulate plans to address the three gaps identified in the five year forward view and that will be a key part of any assurance process nationally that we run. And I suppose the thing in all that will be the relationships between the components of those footprints will be absolutely key in both getting to a good plan but actually giving everybody the confidence that those plans are implementable to enable us to have financially and clinically sustainable services over the next five year period.

It will be very important, and I think it’s quite appropriate that the service expect it that the national bodies are absolutely aligned in our assurance process of those plans. That's across all the arms length bodies but I think particularly between the I and the E and to make sure that the care regulator is absolutely comfortable and confident with what those plans are saying for service development in those patches.

On a very techie point, inevitably there will be some technical things that some footprints might need support and assistance with and we’ll need to make sure that we’re able to do that even if it’s as boring as this is what a medium term financial model looks like if you haven’t been able to determine one yourself, why don’t you have a go at using this. So we’ll go from the hands off where we think that's relevant, a joint assurance process to make sure that we’re getting the relationships right but if we need to provide some particular support then I think it’s right and proper for the service to expect that we will make that forthcoming.

Inevitably there will be the example of, okay, so show us you’re doing something differently, and I suppose the most obvious example that I’d use that we’re in active conversation with is can we get to an absolutely clear single unified way of demonstrating success. So are we able to, with other regulators and oversight body, come up with a framework that says, this is what good looks like, this is how success will be judged, so the piece that we do or that we’re doing with the CQC, for instance, on the development of the use of resources score that will play into the overall rating for the provider side is an absolute key demonstration of both joint working and a singularity of purpose.


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