Chris Hopson: Nine ways to make the NHS fit for 2014

Next week the starting gun will be fired on one of the most important exercises in NHS history − the 2014-15 planning round. The NHS faces an unprecedented financial squeeze, while also needing to create integrated new models of care; reconfigure the service to make it sustainable; improve quality of care and outcomes; and tackle longstanding health inequalities.

‘The 2014-15 planning process is the only game in town, and NHS England needs to be accountable for its success’

This requires a transformation that is starting three years too late because of the focus on creating a new NHS structure. This is, in the words of one very senior health service leader, an “extraordinarily difficult challenge”.

A critical success factor will be the quality of our national and local strategic planning − traditionally a weak point for the NHS. We also have to plan in a new, disparate, NHS structure where some key bodies − NHS England, clinical commissioning groups and health and wellbeing boards − are still finding their feet and building capability.

Each local health economy has to create two-year operational plans, five-year strategic plans and separate integration transformation fund plans. These sit alongside plans for the national NHS system framework. Having overseen strategic planning in a FTSE 100 company and the largest government department, here are nine thoughts (from a provider perspective) on what is needed to make a success of this key exercise:

Commissioner coordinated but pan-NHS, full partnership, planning

While commissioners have to coordinate the planning process, it will only work if all the NHS is fully involved as equal partners. If, for example, each local five-year strategic plan is to identify a long term sustainable pattern of provision, local providers have to be fully involved in that design.

NHS England empowered to coordinate a national process

The 2014-15 planning process is the only game in town, and NHS England needs to be accountable for its success. The Department of Health, Monitor, the Trust Development Authority and other statutory bodies must formally accept NHS England’s lead and align behind this process, so we don’t end up with different plans in different places.

CCGs drawing on all the capability in their local health economy

‘We need a better idea of how they see specialist commissioning working, and how primary care will be reformed’

While CCGs need to coordinate this process at local level, the capability variation between them is significant. In many health economies, much of the strategic planning capability lies with providers. So all parts of each local NHS need to pool their capability and create a genuine partnership that draws on all the available skill and expertise. We also need to identify where this isn’t happening and find a way of providing extra support.

Involving local government and the people

But we don’t just need to link up the NHS − we also need to integrate social care and if (as the NHS England “call to action” says) the NHS belongs to the people, we also need to fully involve them too. Plans need to be patient led, and we need to build public consent for difficult reconfigurations at the start.

The NHS system supporting local planning

‘Separate integration fund plans covering £3.8bn of spending and mainstream plans covering about £65bn seems odd’

In the new structure, local planning is key and transformational change can only come from the bottom up. NHS England and the statutory sector must therefore see themselves as supporters, enablers and facilitators of local planning; not national blueprint providers. They should ask local economies what support they need and then bust a gut to provide it, rather than assume they know what is needed.

NHS England providing more of the national framework

It is difficult to plan locally without a clear national strategic framework. NHS England has set out the future of the urgent and emergency care pathway and seven-day working. We also need a better idea of how they see specialised commissioning working, and how primary care will be reformed.

Linking the integration fund and the main planning process more effectively

Separate integration fund plans covering £3.8 billion of spending and mainstream plans covering about £65 billion seems odd. As does having ministerial approval for the former and CCG approval for the latter. We need one seamless process.

Candour in a tough political climate

This process must be an honest and open exploration of each local health economy’s challenge, and the difficult choices needed to ensure clinical and financial sustainability. Politicians will find this difficult in the run-up to a general election, but the NHS needs to assert its right to conduct a meaningful process.

Parity of esteem for strategic planning

One reason the NHS finds it difficult to plan effectively is the lack of parity of esteem between strategic planning and operational delivery. The service needs to devote at least as much time and energy to this process as it is currently devoting to performance managing the four-hour accident and emergency target.

Wouldn’t it be great if the NHS system was ringing up trust and CCG chief executives three times a day to ensure they had the right support to complete this process effectively?

Chris Hopson is chief executive of the Foundation Trust Network. A longer version of this article can be found at the FTN website