1. Critical issues and success factors
The NHS in England
Critical issues and success factors

2. Headlines
Significant growth funding with years 1 and 5 front ‘loaded’.
Growth above GDP deflator for 5-year period
Yrs 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.

3. 2015 CSR - NHS Settlement
SOURCE: NHS England

4. NHS – National Budget Summary

5. 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

6. NHS Financial context
Analysis produced by the Health Foundation

7. NHS Financial Context
Analysis produced by the Health Foundation

8. Increasing Demand
Analysis produced by the Health Foundation

9. 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

10. National Planning Process

11. 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

12. 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