NHS Operational and Planning guidance 2021/22

NHS Operational Planning and Contracting Guidance

2021/22 priorities and operational planning guidance 25 March 2021

The 2021/22 priorities and operational planning guidance sets the priorities for the year ahead, against a backdrop of the challenge to restore services, meet new care demands and reduce the care back logs that are a direct consequence of the pandemic, whilst supporting staff recovery and taking further steps to address inequalities in access, experience and outcomes.

Priorities for the year ahead:

A. Supporting the health and wellbeing of staff and taking action on recruitment and retention

B. Delivering the NHS COVID vaccination programme and continuing to meet the needs of patients with COVID-19

C. Building on what we have learned during the pandemic to transform the delivery of services, accelerate the restoration of elective and cancer care and manage the increasing demand on mental health services

D. Expanding primary care capacity to improve access, local health outcomes and address health inequalities

E. Transforming community and urgent and emergency care to prevent inappropriate attendance at emergency departments (ED), improve timely admission to hospital for ED patients and reduce length of stay

F. Working collaboratively across systems to deliver on these priorities.

NHS Operational Planning and Contracting Guidance 2020/21

NHS Operational Planning and Contracting Guidance 2020/21
NHS England 31 January 2020
(Part of NHS Operational Planning and Contracting Guidance)
Summary of the guidance as currently drafted and sets out the timetable for the submission process NHS England Board meeting 31 January 2020 Summary paper.

Watch the NHS Board meeting discussion of "system by default" here. (38m09s - 54m:25s)

• Details concerning key technical elements of the operational planning process, covering CCG mergers, narrative plans, submission process overview, Better Care Fund planning requirements as well as key contacts, resources and timetable.
• Plans include to "embed and strengthen the governance of our systems as we move to a ‘system by default’ operational model and prepare all systems to become an Integrated Care System (ICS) by April 2021."

From NHS E/I bulletin 31 January 2020

"The planning guidance requires the NHS to build on the local system-wide strategic plans developed during 2019, and to deliver in 2020/21 the commitments in those plans. This will mean expanding urgent and emergency care to meet demand, eradicating waits of 52 weeks or more, ensuring at least 70% of people with cancer receive a diagnosis within 28 days, and continuing to expand mental health services. It also sets out plans to increase the number of general practice appointments and the number of primary care staff. The guidance covers system planning, operational plan requirements, details of workforce transformation requirements, the financial settlement and the process and timescales around submitting plans."

NHS accountability framework 2019 to 2020

NHS accountability framework 2019 to 2020
DHSC 21 May 2019

• This Accountability Framework with NHS England and NHS Improvement, which includes the Government's statutory mandate to NHS England, sets out the expectations for NHS England and NHS Improvement in 2019-20 to deliver the first year of the Long Term Plan and address the immediate needs associated with EU Exit. A further Accountability Framework will then cover the following four-year period.
• Annex A sets out the NHS Long Term Plan and NHS Planning Guidance commitments for 2019-20

Preparing for the possibility of a ‘no deal’ EU exit for primary care contractors

Preparing for the possibility of a ‘no deal’ EU exit for primary care contractors
NHS England 11 April 2019

• A letter from Professor Keith Willett, EU Exit Strategic Commander and Dr David Geddes, Director of Primary Care Commissioning, following from EU Exit Operational Readiness Guidance for the health and care system, published by DHSC 21 December 2018.
• The letter outlines what has been done nationally to assess the potential risks to primary care, and give clear direction on the actions that contractors delivering primary care still need to take locally.
• Contingency planning for a ‘no deal’ EU exit has focussed on the following areas:
• Continuity of supply
• Non-clinical goods and services
• Reciprocal Care
• Workforce
• Data
• Research and clinical networks
• Raising concerns

Putting the NHS Long Term Plan into action : Planning and Contracting Guidance 2019-2020

Putting the NHS Long Term Plan into action : Planning and Contracting Guidance 2019-2020
NHS Confederation 14 January 2019

• The Guidance sets out full operational plan requirements, covering system planning, the financial settlement, and the process and timescales around the submission of CCG, NHS Provider and system plans.
• Accompanies five-year indicative CCG allocations.
• Includes a table of timescales

CCG allocations 2019/20 to 2023/24 and Operational planning and contracting guidance 2019/20

CCG allocations 2019/20 to 2023/24
NHS England 10 January 2019

• Draft allocations for 2019/2023/24 including a document setting out the changes made to target CCG allocations for 2019/20, the pace of change rules, and the assumptions used to set the overall CCG allocations growth rate. 

NHS Operational Planning and Contracting Guidance 2019/20
NHS England updated 10 January 2019

• Updated system planning, financial settlement, full operational plan requirements, and the process and timescales around the submission of plans.

Developing the long-term plan for the NHS

Developing the long-term plan for the NHS
NHS Providers 9 August 2018

• This briefing summarises the NHS England and NHS Improvement stakeholder briefing on the long term plan for the NHS and outlines what is known about the plan.
• For up to date information see the NHS Improvement page.

Planning, assuring and delivering Service Change for Patients

Planning, assuring and delivering Service Change for Patients
NHS England updated 22 March 2018

• A good practice guide for commissioners on the NHS England assurance process for major service changes and reconfiguration (including decommissioning).
• It sets out how new proposals for change are tested through independent review and assurance by NHS England, taking into account the framework of Procurement, Patient Choice and Competition Regulations. 
• CCGs are under a statutory duty to have regard to this guidance.

Integrated Care Systems - Refreshing NHS Plans for 2018/19

Refreshing NHS Plans for 2018/19
NHS England 2 February 2018

• This guidance builds on guidance set for 2017/19 to enable organisations to continue to work together through STPs to develop system-wide plans that reconcile and explain how providers and commissioners will collaborate to improve services and manage within their collective budgets. The guidance outlines "additional freedoms and flexibilities" which will support the most advanced Integrated Care Systems to lead this process.
• NHS England are now using the term ‘Integrated Care System’ as a collective term for both devolved health and care systems and for those areas previously designated as ‘shadow accountable care systems’. An Integrated Care System is where health and care organisations voluntarily come together to provide integrated services for a defined population. (page12)
• The guidance is accompanied by revised clinical commissioning group allocations for 2018/19.

Extract from p12:
4 We see Integrated Care Systems as key to sustainable improvements in health and care by:
• creating more robust cross-organisational arrangements to tackle the systemic challenges facing the NHS;
• supporting population health management approaches that facilitate the integration of services focused on populations that are at risk of developing acute illness and hospitalisation;
• delivering more care through re-designed community-based and homebased services, including in partnership with social care, the voluntary and community sector; and
• allowing systems to take collective responsibility for financial and operational performance and health outcomes.

Technical Guidance for Refreshing NHS Plans 2018/19

NHS England 23 February 2018

Making sense of Integrated Care Systems

Making sense of Integrated Care Systems
Chris Ham, Kings Fund 20 February 2018

• In its refreshed NHS Plans for 2018/19  NHS England has changed the name of accountable care systems (ACSs) to integrated care systems (ICSs). In this "long read" Chris Ham looks at the work under way and explains the terminology. 

NHS England Board meeting 29 September 2016

NHS England Board meeting 29 September 2016

Video will be available here:

Agenda

Item 1: Public Agenda
Item 2: Minutes of previous meeting held on 28 July 2016
Item 3: Chief Executive’s Report (verbal)
Item 4: NHS operational planning and contracting guidance 2017-19
Item 5: Primary and Acute Care Systems (PACS) and Enhanced Care in Care Homes (ECH)
Item 6: New care models in Tertiary Mental Health Services
Item 7: Improving the quality of customer insight through NHS Citizen
Item 8: Corporate and NHS Performance report
Item 9: NHS Finance Report
Item 10: Use of NHS England Seal
Item 11a: Commissioning Committee Report
Item 11b: Report from Investment Committee
Item 11c: Specialised Services Commissioning Committee
Item 11d: Audit and Risk Assurance Committee (no paper)

NHS Operational Planning and Contracting Guidance 2017 – 2019

Delivering the Forward View: NHS Operational Planning and Contracting Guidance 2017 – 2019
NHS England and NHS Improvement, 22 September 2016

• The Planning Guidance provides local NHS organisations with an update on the national priorities for 2017/18 and 2018/19, as well as updating on longer term financial challenges for local systems.
• The guidance covers two financial years and is underpinned by a two-year tariff and two-year NHS Standard Contract.
• Drawing on existing data collections from the assurance frameworks, NHS England will publish core baseline STP metrics in November 2016 around Finance, Quality and Health outcomes and care redesign.
• NHS England expect all contracts to be signed by 23 December 2016 - see the timetable for deadlines around publications, submission and mediation processes.
• The business rules for commissioners for 2017/18 and 2018/19 are set out in full in Annex E of the accompanying technical guidance.

Commissioning in the evolving system (p29) - this section outlines the future role of CCGs

"CCGs’ role will continue to evolve. As new care models are established, the boundary between what is done by CCGs and by new integrated care providers will shift. However, there will continue to be a need for an effective commissioning function in the NHS. This includes acting as funder, setting local priorities and incentives, oversight of contracts, ensuring best value for the taxpayer, and ensuring the provision of a comprehensive local NHS within the available resources."

CCG Financial Performance and Accountability - The "Financial Reset Plan"

Strengthening Financial Performance and Accountability in 2016/17
NHS England 21 July 2016

• NHS England has set out a series of actions designed to support the NHS to achieve financial sustainability and improve operational performance.
• A wide-ranging seven-point set of actions is being taken by NHS Improvement, NHS England with the support of the Department of Health and the Care Quality Commission. 
• They have:
• allocated an extra £1.8 billion to trusts, with the aim set by NHS Improvement of cutting the combined provider deficit to around £250 million in 2016/17 and the ambition that, in aggregate, the provider position commences 2017/18 in run-rate balance;
• replaced national fines with trust-specific incentives linked to agreed organisation-specific published performance improvement trajectories, so as to kick-start a multi-year recovery and redesign of A&E and elective care;
• agreed ‘financial control totals’ with individual trusts and CCGs, which represent the minimum level of financial performance, against which their boards, governing bodies and chief executives must deliver in 2016/17, and for which they will be held directly accountable;
• introduced new intervention regimes of special measures which will be applied to both trusts and CCGs who are not meeting their financial commitments;
• set new controls to cap the cost of interim managers and to fast track savings from back office, pathology and temporary staffing;
• published the 2015/16 performance ratings for CCGs; and
• launched a two-year NHS planning and contracting round for 2017/18-2018/19, to be completed by December 2016, and linked to agreed STPs.
• The document is described as "the financial reset document" in the NHS Finance report to the NHS England Board meeting 28 July 2016.

STP June 30th submission guidance

STP June 30th submission
NHS England 23 May 2016

• This short note is a guide for STP footprints on what the national bodies would expect to see in STP submissions, which are due on the June 30th 2016. It outlines how initial submissions should be developed.
• There will not be a standard submission template apart from a shared financial template for each footprint to show it could close its financial gap for NHS services and achieve sustainable financial balance in aggregate by 2020/21.
• ANNEX – Topics to cover in June

1. Executive summary / plan on a page 
2. Starting point [as set out in April submission] 
3. Priorities and transformation schemes 
4. Solutions that taken together close the gaps, and its impact quantified – health and care being described as concretely as possible in terms of expected effect on metrics. 
5. How to deliver your plan 

• Also Governance arrangements, Engagement process and Enablers 

NHS Planning Guidance timeline

Timeline for transformation
NHS Confederation

• Key dates and milestones in the 2016/17 planning process with an interactive timeline and at-a-glance guide.

Non-recurrent spend to create a risk reserve : Additional technical guidance

Utilisation of 1% non-recurrent spend to create a risk reserve : Additional technical guidance – Financial Planning 2016/17
NHS England February 2016

• “To contribute to the health system risk management, HM Treasury has stipulated that all commissioning organisations (with the exception of Specialised & Public Health…) must make sure that the 1% non-recurrent spend (as required by the business rules) is fully uncommitted at the start of the financial year.” 
• The Guidance outlines process for release and monitoring.
• Part of NHS Shared Planning Guidance 

Supporting providers to deliver the Five year Forward View

Implementing The Forward View: Supporting providers to deliver
NHS Improvement, 11 February 2016

• This report is for NHS provider organisations and is part of a series of planned roadmaps that draw on messages from the NHS shared planning guidance. It sets out the key priorities for the organisations responsible for delivering high quality health and care this year and beyond.
• This report

• outlines the challenges and changes ahead
• describes a coherent set of activities for NHS providers in the coming years
• shows how providers across the country are beginning to deliver these
• outlines the support providers can expect from NHS Improvement
• It sets out the task and clear expectations of what needs to be delivered and brings together all the key requirements into one document while providing links to the detail.

National Voices briefing on Planning guidance

National Voices Member briefing: NHS planning guidance 2016/17 – 2020/21
National Voices 9 February 2016

• National Voices has published a 3 page member briefing covering key information about the NHS Planning Guidance outlining the requirement for engagement of patients, service users, carers and the public in developing plan, as well as importance of engaging with voluntary and community groups.
• National Voices has created a template letter for member organisations to contact their local CCG requesting to be involved in the planning process.

What the planning guidance means for the NHS 2016/17 and beyond

What the planning guidance means for the NHS 2016/17 and beyond
Kings Fund 5 February 2016

• This briefing considers some of the key publications and policy announcements that have come out in the wake of the 2015 Spending Review and offers a commentary on what they might mean for the future landscape of the NHS.
• It begins by pulling out the key points of note from the range of documents published to date and then offers an assessment of what they mean in broader policy terms. 


• Key messages
• The approach set out for 2016/17 and beyond represents a watershed moment for the NHS.
• Changes to the way the system works, such as the introduction of multi-year allocations and the shift towards place-based systems of care – if implemented well – will give the NHS strong foundations from which it has a chance of achieving sustainability in the long term.
• The place-based approach represents an important acknowledgement that the now-widespread deficits are not simply a provider problem and that creating a sustainable financing model requires commissioners, providers and local authorities to work together.
• Guidance from central bodies signals an end to the post-Francis era. It has been made clear that the system has reached a point where finance must be given much greater priority.
• Gone too are core elements of the Health and Social Care Act 2012, in particular, the emphasis on competition and the principle of autonomy, with national bodies re-asserting control in order to get a strong grip on finances and performance.
• Frontloading of the Spending Review settlement means that, if and when the NHS has the capacity to progress from deficit reduction to transformation, it will be doing so against a backdrop of much smaller funding increases. It is inconceivable that the NHS will be able to achieve both financial sustainability and large-scale transformation within these financial constraints.
• The numerous and complex demands being placed on the NHS come at a time when many organisations are already under huge pressure. National bodies should be clear about the most important priorities, recognising that not everything can be delivered within the funding available.
• Leaders will need to work collaboratively in place-based systems of care. It will be critical that organisations engage staff at all levels in achieving sustainability and delivering transformation, and focus on improving value for patients and not crude cost-cutting.

Technical Guidance for NHS planning 2016/17

Technical Guidance for NHS planning 2016/17
NHS England, January 2016

• Operational plan timetable - key dates:
• Submission of full draft 2016/17 operational plans - 8 February
• Submission of updated full draft plans (CCGs, NHS England only) - 2 March
• National deadline for signing of contracts By 31 March 
• Budgets and final plans approved by Boards of providers and commissioners By 31 March
• Submission of final 2016/17 operational plans, aligned with contracts -11 April
• Annexes 
• Annex 1: Activity Plan, Contract Tracker and SRG Operational Resilience Template Guidance
• Annex 2: NHS England guidance on commissioner operational plans 
• Annex 3: Guidance for completion of commissioner finance templates
• Annex 4 – Better Care Fund in 2016-17 (not yet published)
• Annex 5: NHS Improvement Guidance on Provider Operational Plans
• Annex 6: Annual Plan Review Template Guidance for NHS Foundation Trusts
• Annex 7: Trust Financial Management System (TFMS) Plan Guidance
• Annex 8: Workforce Plan Technical Guidance for NHS Trusts
• See NHS England NHS Shared Planning Guidance webpage for full documentation.