Critical issues and success factors The NHS in England Critical issues and success factors 2016-21

Headlines Significant growth funding with years 1 and 5 front ‘loaded’. Growth above GDP deflator for 5-year period Yrs 2-4 - funding growth at a minimum. £22bn financial gap to 20/21. £3.7bn underlying Provider financial deficit in 2015/16 Historic levels of financial problems Average annual growth rate in activity running ca 3-3.5%. Higher for Prescribing Performance under pressure New transformation and sustainability fund set up STPs created New Vanguards and Devolution signal move away from established landscape.

2015 CSR - NHS Settlement SOURCE: NHS England

NHS – National Budget Summary

Spending Review Settlement £8.4 billion real terms increase for the NHS by 2020/21, front-loaded to: implement the Five Year Forward View (closing health, quality and finance gaps); restore and maintain financial balance; and deliver core access and quality standards for patients. Of this £8.4bn total settlement, the NHS will receive a £5.4bn cash increase (£3.8bn real terms) in 2016/17: Sustainability and transformation funding £1.8bn Commissioner allocations £3.5bn New policy initiatives (held centrally) £100m SOURCE: NHS England

NHS Financial context Analysis produced by the Health Foundation

NHS Financial Context Analysis produced by the Health Foundation

Increasing Demand Analysis produced by the Health Foundation

Sustainability and Transformation Plans (STPs) Every health and care system must come together to create an STP – its own ambitious local blueprint for accelerating its implementation of the Five Year Forward View Content of Plans STPs are umbrella plans Planning by place for local populations Success depend on system leadership; and an open, engaging, and iterative process with clinicians, patients, carers, citizens, and local community partners Plans will cover all commissioned activity, and demonstrate better integration with local authorities STPs cover the period October 2016 to March 2021 – operational plans are considered as year one of the STP Transformation Footprints Transformation footprints must together form a complete national map Local authorities must be engaged Transformation footprints should be locally defined Important to get this right locally, there is no centrally handed down right answer The scale of the planning task may point to larger rather than smaller footprints Local health and care systems made proposals for their transformation footprint in January 2016 SOURCE: NHS England

National Planning Process

Planning 2017/18-18/19: Moving to bigger scale Impact of ‘Re-set’ and STF. Develop a clinical Case for Change. Put Clinical leadership at the heart of planning. Establish Clinical leads and reference groups for all areas of affected by Case for Change. Scale up opportunities for Provider collaboration. Planning moving to STP footprints for 2017/18. Commencing with initial two-year contracts. Big emphasis will be on: Tackling unwarranted variation in care. Improving poor outcomes. Look at how quality and safety will be maintained and improved. Be efficient and effective in the way services are provided. Outline how Organisations work within new STP footprint. Strengthening leadership models SOURCE: NHS England

Options for Closing the Gap Creation of STPs and move to ‘scale’. Provider Productivity Regulatory frameworks Reducing hospital activity Addressing sub-scale and frail services Specialised Commissioning 5-year plan. Further focus on medicines optimisation New Vanguard care model move away from tariff Devolution – e.g Manchester/London Radical overhaul of NHS estate Shifting activity into Primary/Community Care settings Impact of Brexit needs to be managed Implications of non-delivery are very difficult