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Trust News: NHS Improvement unveils tough plan for budget ‘reset’

New trust and patient safety watchdog NHS Improvement launched a bullish 2016-17 business plan in July which could have a tangible impact on members in hospitals.

Chief Executive Jim Mackey, formerly CEO of Northumbria Healthcare Foundation Trust, has made waves recently, not least in a Health Service Journal interview where he suggested hospitals may be overstaffing in the wake of the Francis Report into safe care.

The watchdog’s business plan warns trusts the government’s additional investment to the NHS “is heavily weighted to the earlier years of the spending period for a reason: this is the time for the NHS to invest in making lasting improvements in the quality and efficiency of care so that standards can be sustained as funding growth slows later in the period.”

This presented “an opportunity – and an obligation – that the NHS cannot afford to miss.”

NHS Improvement’s goals, grounded in NHS England’s Five Year Forward View, include implementing the Carter Review recommendations on hospital workforce productivity, procurement and reduced agency spend.

It also underlined its aim of reducing trusts’ collective debts from £2.5 billion in 2015-16 to nil in 2017-18, in part by delivering a 2 per cent efficiency target this year.

NHSI has demanded that all trusts sign up to a control total – a budget target that enshrines spending cuts and rationalisation – in return for access to some of the £1.8bn Sustainability and Transformation Fund.

Those trusts that fail will be punished, with five which refused to sign up already placed in “special measures” – Barts Health, Croydon Health Services, Maidstone and Tunbridge Wells, Norfolk and Norwich and North Bristol.

Another dozen trusts that have not agreed savings targets may face similar treatment.

At the same time NHS Improvement has set out the goal of improving A&E performance through a “co-ordinated effort across health and social care systems to resolve the drivers of poor A&E performance.”

Its focus will be on reducing admissions, unblocking internal patient flow within hospitals, and the discharge and transfer process.

Meanwhile new trial models of care, already being rolled out via Vanguard projects, will be supported as part of a core Forward View vision for more centralised and collaborative area-based services.

NHS Improvement also unveiled a “new work programme” aimed at encouraging private-sector involvement in trust work across the NHS, including “mainstreaming clinical capacity for elective, outpatient and diagnostic care” and “joint ventures and/or outsourcing of new, novel or restructured clinical services.”

The stakes are high for hospitals, their workforce and patients, but NHSI’s hard-line approach comes in the wake of a major wobble in the Department of Health’s finances.

Its annual accounts in July showed that it had to transfer £950 million from capital funds to avoid parliamentary censure for seriously breaching its £114.7bn budget.