In part this is because these trusts will remain hugely dependent on central financial support (see Figure 7). In 2018/19, NHS England and NHS Improvement had three expectations for the A&E standard: that national performance is above 90 per cent for the month of September 2018; that the majority of providers are achieving the 95 per cent standard for the month of March 2019; and that the NHS returns to 95 per cent overall performance within the course of 2019. 2018/19 For example, the number of patients waiting more than a year for planned care was more than halved from 2,756 people in March 2018 to just over 1,000 people by March 2019. Even if it is a time of (relative) plenty for NHS funding, this is certainly not the case when it comes to the supply of clinical staff or investment in the vital health and care budgets that lie outside the NHS ringfence. The results were then sorted into the five bands based on a calculation of how that performance compared to the average on a scale where 100 is the best and 0 the worst. I have a few friends and colleagues who lost their jobs because of the financial performance of their organisation. Please activate cookies in order to turn autoplay off. Photograph: Murdo Macleod/Guardian, We have switched off comments on this old version of the site. Covid-19 has dramatically altered how NHS services and finances operate. Second, a Commissioner Sustainability Fund (CSF) was created to mirror the financial framework for providers. For this reason, we asked finance directors for their views on the proposed changes to the four-hour A&E standard. And the third bucket was a nuanced reminder that system working is not a substitute for financial discipline and focus at the organisational level. While adult social care was top of the pile of priorities, the responses of finance directors illustrated the importance of all the unprotected areas of health and care spending (see Figure 11). The suite of access standards proposed in the interim Clinical Standards Review document are currently being piloted in a small number of NHS trusts. The demand for emergency services continues unabated, with emergency admissions to hospital relentlessly ratcheting up year after year. The financial commitments in the NHS long-term plan were not the only things to catch the eye. Staffing costs account for the majority of health care spending, and the NHS is part of an interconnected system of public services. NHS England and NHS Improvement have said their ambition is that the financial recovery fund will mean the end of the control total regime and associated PSF for all trusts from 2020/21. As one NHS finance lead, who had seen their public health contracts more than halve since 2013/14, said: ‘this means reductions in health visiting, school nursing, no family nurse partnership service, no substance misuse community service, cuts in oral health promotion – all this in [a city] which has one of the highest deprivation levels and numbers of young people.’ (NHS trust finance director). Manchester Mental Health and Social Care NHS Trust had the lowest score in the country, with only 45% of staff recommending it. NHS Improvement Use of Resources for King’s College Hospital NHS Foundation Trust The CQC inspections and interviews took place between Wednesday 30 January 2019 and Thursday 21 February 2019. If performance is this challenged over the summer, it is hard to see how the NHS will meet the required standard at all this year – especially if the worryingly high levels of flu activity in the Antipodes are a preview of the pressures that might hit the NHS in winter. And these responses fell into three broad buckets. We end this section where it began – with the 2018/19 planning guidance. But, in some parts of the country at least, it is hard to see how the financial performance of the system and the organisation can be given equal priority. There has been an unhelpful tendency in recent years to redefine ‘health spending’ as being just NHS England’s budget (or more recently, funding covered by the NHS England mandate) rather than the total Department of Health and Social Care budget, and to protect health spending without due regard to social care and public health budgets. From the responses we received, the jury is still out. These are a target that 95 per cent of patients will be admitted, transferred or discharged within four hours of arriving at an A&E department, and a target that 92 per cent of patients should wait no more than 18 weeks for planned elective treatment after a referral for consultant-led care. There was clear support for introducing new measures of how long patients wait in A&E before being clinically assessed or receiving treatment. providers to maintain or reduce the number of patients on planned care (referral-to-treatment) waiting lists in March 2019, compared to March 2018; and to halve the number of patients waiting more than a year for care. Some of these commitments were met. Funding from the PSF was paid out to organisations, mainly acute trusts, that agreed to their nationally set ‘control total’ (financial target). The current timetable for the review leaves precious little opportunity for this to happen. This is a far higher degree of pessimism when compared to their own organisation’s financial performance (Figure 6), perhaps reflecting the wider pressures on primary care, social care and public health services. The 2018/19 planning guidance did not explicitly mention the 18-week standard itself. For example, finance leads highlighted how underinvestment in capital spending for IT, equipment and facilities has led to deteriorating performance, efficiency and staff morale. Two of the highest profile NHS targets are for emergency care and planned elective care: the four-hour A&E and the 18-week referral-to-treatment standards. And this will have serious consequences for wider services, such as adult social care and public health, and delays to the final NHS People Plan. Trusts in Band 5, the best safety rating (and their patient safety scores): University College London Hospitals NHS Foundation Trust (100), Cambridge University Hospitals NHS Foundation Trust (99.32), Guy’s and St Thomas’ NHS Foundation Trust (98.63), Chelsea and Westminster hospital NHS Foundation Trust (97.26), South Tees Hospital NHS Foundation Trust (95.89), Brighton and Sussex University Hospitals NHS Trust (94.52), Frimley Park Hospital NHS Foundation Trust (94.52), Mid Staffordshire NHS Foundation Trust (93.84), Imperial College Healthcare NHS Trust (93.84), East Kent Hospitals University NHS Trust (92.47), Trusts in Band 1, the worst safety rating (and their patient safety scores), Blackpool, Fylde and Wyre Hospitals NHS Trust (6.16), St Helens and Knowsley Hospitals NHS Trust (5.48), University Hospital of South Manchester NHS Foundation Trust (4.79), University Hospitals Coventry and Warwickshire NHS Trust (3.42), Scarborough and North East Yorkshire Health Care NHS Trust (2.05), Basildon and Thurrock University Hospitals NHS Foundation Trust (0), Bumper Asos profits show consumers don’t care about industry ethics, Joe Biden denies meeting Burisma official as purported Hunter Biden emails leaked, Teenagers will escape drug prosecutions under new initiative to combat county lines gangs, Elton John resolves legal row with ex-wife who sued him after claiming Rocketman film breached divorce agreement, UK's most serious criminals avoid handing over £2bn in crime assets. While withholding funding will increase deficits reported by individual organisations, it will not alter the net overall NHS position, as the sustainability funds will be underspent by the equivalent amount. Providers who accepted their financial control totals were exempt from some contract performance sanctions, such as fines for missing waiting time targets. 2018/19 brought two changes to national management of provider and commissioner finances. Second, there is a concern that, although reducing outpatient numbers will improve patient care and convenience, this will not necessarily reduce costs to the NHS (an implicit goal of the new NHS target) unless this results in reduced staffing or estate costs. The assessment covers all 392 NHS trusts in England and also measures 86 other indicators such as waiting times for patients and ambulance response times. Figure 5 below shows just how volatile individual provider finances were over 2018/19 with some particularly striking variances to plans. The guidance noted that ‘the delivery of plans in 2018/19 is an essential foundation for the longer-term sustainability of services … Any shortfall in delivery during 2018/19 would have significant implications for the following year.’ At the start of 2018/19, this could be read as imploring providers and CCGs to redouble their efforts. Providers who rejected their control totals were ineligible for central sustainability funding and any discretionary access to capital allocation. And the current ‘financial reset’ may concern the removal, rather than introduction, of control totals.

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