NHS England has published its delivery plan Next steps on the NHS five year forward view.

The plan sets out how the service will deliver improvements in cancer, mental health and GP access and how it plans to transform the way care is delivered to ease pressure on hospitals.

The publication comes two-and-a-half years after the NHS Five year forward view and sets out what has been achieved so far.

Commenting on the plan published today, the chief executive of NHS Providers, Chris Hopson said:

“We welcome the plan’s recognition of the scale of challenge the NHS faces - rapidly rising demand, the longest and deepest financial squeeze in NHS history and growing staff shortages.”

On the task facing NHS trusts in 2017/18 and 2018/19

“Two weeks ago, in our Mission impossible? report, we set out how impossible the task was for NHS trusts in 2017/18 and we called for greater realism. We therefore welcome the new performance trajectories for the key four hour A&E and 18-week elective surgery targets next year. But we do need to remember the impact on patients. More will have to wait longer in A&E and for routine surgery than they should. That’s why, in our report, we said that NHS trusts would much prefer to be properly funded to meet the NHS constitutional standards.

“Trusts look forward to working with NHS England and NHS Improvement to finalise two key details not covered in the plan.

We welcome the new performance trajectories for the key four hour A&E and 18 week elective surgery targets next year. But we do need to remember the impact on patients.

“First, we need to finalise the 2017/18 financial targets. Our recent survey of trust finance directors estimated a £1bn gap in the 2017/18 budget if trusts are to achieve the required financial balance. Given the new financial year starts tomorrow we need to rapidly work out how to fill this gap and what the overall provider sector financial target should be. We believe trusts will be doing well to reproduce this year's likely performance of an £800-900m deficit.

“Second, we need to work out what can actually be delivered in 2018/19 given that NHS frontline funding increases drop even further from +3.6% in 2016/17 to +1.3% in 2017/18 and then to +0.4% in 2018/19. This means that NHS real terms spending per person (adjusting for age) will actually decrease in 2018/19 - a very rare occurrence.

“We also welcome the explicit acknowledgement in the plan of the scale of risk facing NHS trusts in delivering all they are required to in 2017/18. We must not forget how difficult this winter was for staff and patients with unacceptable levels of patient safety risk. We need to ensure this risk is much better managed next winter. For example, the NHS needs between 2,000 and 3,000 beds freed up as a result of the extra £1bn social care funding allocated in the Budget. Without this, or other extra capacity, the plan’s A&E performance trajectories in the second half of 2017/18 already look very difficult indeed – even though these are already below the NHS constitutional standard.

“Trust leaders also recognise the importance of their role in delivering the new cancer and mental health improvements for patients and service users. It is important that we continue to make progress in these two areas.”

On the development of sustainability and transformation plans (STPs)

“We welcome the pragmatic and flexible approach to developing STPs. The plan recognises that the 2012 Health and Social Care Act prevents the creation of a formal ‘mid-level STP tier’ with statutory powers.

“The plan also recognises the importance of existing governance and accountability structures focused on trusts, but also the opportunity for shared decision-making at the STP level.

“Finally, it allows different STPs to move at different speeds: enabling the fastest to progress without delay but not forcing others to adopt a single uniform approach they neither want nor are ready for.

“We look forward to working with NHS Improvement and NHS England on the details of how STPs will develop in future over the next few weeks.”

Trust leaders tell us that concerns over workforce are now at the top of their worry list. This includes concerns about growing staff shortages, the unsustainable pressure on staff and the viability of maintaining a 1% pay cap.

On workforce

“Trust leaders tell us that concerns over workforce are now at the top of their worry list. This includes concerns about growing staff shortages, the unsustainable pressure on staff and the viability of maintaining a 1% pay cap. We note the workforce proposals in the plan and will want to test with NHS trusts whether these really do represent a viable and sustainable solution.”

On the future strategic direction of the NHS

“We welcome the restatement of the NHS Five year forward view vision of closing the health, care and financial gaps and the move to new care models, which we strongly support.

“We also welcome recognition that transformation at the required speed can only occur with capital investment and by growing capacity closer to people’s homes in the community. The Chancellor’s commitment to address these needs in the Autumn Statement is welcome but the detail of how that commitment is met will be important. Trust leaders tell us they are very worried by the current approach to capital – it is short-sighted and unsustainable to carry on robbing capital budgets to prop up daily running costs

The plan reinforces a simple, stark, truth: that you get what you pay for.

“Transformation also requires the right leadership capacity that is in desperately short supply given the increasing fragility of services and the leadership time required to keep them stable.”

Summary

“The plan reinforces a simple, stark, truth: that you get what you pay for. Trusts will do all they can to transform and realise efficiencies as quickly as possible. But if NHS funding increases fall way behind demand and cost increases NHS services inevitably deteriorate. That is clearly now happening.”