How can the NHS improve operational and financial sustainability?

Peter Saunders
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The financial and operational challenges which the NHS face are immense. Peter Saunders explains why the health service's joint forward plans are an opportunity for a long-term approach to sustainability that can also absorb short-term pressures.

In our response to the 2023 Spring Budget we pointed to the delays in the publication of annual NHS planning guidance for England and the continued short-term planning horizons for funding and operational targets. This approach limits the ability for health services to plan for and demonstrate sustainability of their services.

The 2024/25 guidance was eventually released just a few days before the start of the financial year and the the priorities emphasised by it: recovering core services, supporting the workforce, and improving productivity, are well trodden paths and themes which have been at the forefront of NHS management for a number of years. The guidance did, however, point to the need to prepare for the future around developing system-level joint forward plans (JFPs); addressing population health, and joining up services with integrated workforce, infrastructure, and digital strategies. 

 While establishing JFPs is a useful step forward, we've seen before how well-intentioned long-term plans developed nationally and locally get overridden by the day-to-day operational issues, and increasingly the financial squeeze and distress many local NHS systems are facing.

The NHS needs to take this opportunity to not only set out a long-term picture for the delivery of local healthcare services, but also align more detailed plans to create a path to operational and financial sustainability. Management has to break the cycle of short-term fixes and planning horizons to deal with the complexity, challenges, and pressures it faces on a day-to-day basis. Three-five year plans aligned with JFPs should be clear operational and financial maps. 

These are the key priorities that need to be included in the plans. 

Finance, workforce, and activity

 A clear and shared understanding of the current position that models the impact of interventions and scenarios and delivers a route to sustainability in the the medium to long term that assures the system, regulators, and public that services are sustainable.

Capital and infrastructure

A clear, prioritised, and funded plan for the use, maintenance, and development of NHS estate that ensure asset-utilisation is maximised and provides a safe environment for delivering care.

Transformation and efficiency

Long-term system transformation and efficiency programmes that underpin financial, operational, and infrastructure plans, and deliver improvements in population health and patient care.

For more insight and guidance, get in touch with Peter Saunders

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