NHS action to strengthen trusts’ and CCGs’ financial and operational performance for 2016/17

The NHS today (Thursday) takes action to dramatically cut the annual trust deficit, and sharpen the direct accountability of trusts and CCGs to live within the public resources made available by Parliament and the Government in 2016/17.

In a comprehensive seven-point set of actions, NHS Improvement and NHS England, with support from the Department of Health and the Care Quality Commission, have now:

  • 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; (full allocation details are being published today)
  • 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; (full trust-level performance trajectories are being published today)
  • 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; (control totals for every trust and CCG are published today)
  • introduced new intervention regimes of special measures which will be applied to both trusts and CCGs who are not meeting their financial commitments; (details are being published today)
  • set new controls to cap the cost of interim managers in CCGs and CSUs, and to fast track savings from back office, pathology and temporary staffing for providers;
  • published the 2015/16 performance ratings for CCGs; (the ratings for every CCG are published today) and
  • today announced a two-year NHS planning and contracting round for 2017/18-2018/19, to be completed by December 2016, and linked to agreed Sustainability and Transformation Plans.

NHS Improvement is setting out three specific areas for further action by NHS providers: managing excessive paybill growth; accelerated implementation of Lord Carter’s recommendations on back office, and the consolidation of unsustainable planned care services. Taken together, these are intended to deliver a provider sector deficit of around £250m in 2016/17 and the ambition that, in aggregate, the provider position commences 2017/18 in ‘run rate’ balance.

Access to the 2016/17 £1.8bn Sustainability Fund will partly depend on providers meeting agreed control totals and spending limits as well as their individually agreed performance trajectories published today for key waiting standards in A&E, Referral to Treatment (RTT) and cancer. The two national organisations are putting in place an A&E Improvement Plan and an RTT Recovery Plan to support providers in meeting these.

The first five providers to enter financial special measures are confirmed as:

  • Barts Health NHS Trust;
  • Croydon Health Services NHS Trust;
  • Maidstone and Tunbridge Wells NHS Trust;
  • Norfolk and Norwich University Hospitals NHS Foundation Trust; and
  • North Bristol NHS Trust.

Using criteria announced last year, the CCG annual ratings show how each CCG has discharged its responsibilities. 10 CCGs were rated ‘outstanding’, a further 82 ‘good’ and 91 were found to ‘require improvement’. At the same time, NHS England is taking action with each of the 26 CCGs rated as ‘inadequate’. CCGs newly placed in special measures will include:

  • Coventry and Rugby CCG;
  • Croydon CCG (based on its financial position in quarter 1 of 2016/17 – the CCG was rated as ‘requires improvement and not ‘inadequate’ in 2015/16);
  • East Surrey CCG;
  • Enfield CCG;
  • North Somerset CCG;
  • North Tyneside CCG;
  • South Gloucestershire CCG;
  • Vale of York CCG; and
  • Walsall CCG.

For 2016/17 onwards, NHS England is today introducing a comprehensive, rigorous and transparent new approach to CCG ratings. CCGs will be rated in 29 areas, underpinned by 60 indicators, all made available to patients for the first time on the myNHS website. 41 of these indicators are published online today. The new areas include six clinical priorities matching those set out in the NHS Five Year Forward View, which will be assessed annually by independent expert panels. These are: cancer; dementia, diabetes; learning disabilities; maternity; and mental health.

Jim Mackey, Chief Executive at NHS Improvement said: “This suite of measures will help ensure that the providers facing the greatest financial challenges are supported to bring about rapid financial recovery, while maintaining or improving quality. This plan is intended to restore financial discipline and ensure ongoing financial sustainability across the whole NHS.”

Simon Stevens, Chief Executive of NHS England, said: “Precisely because the pressures across the NHS are real and growing, we need to use this year both to stabilise finances and kick-start the wider changes everyone can see are needed. Most trusts and CCGs know what needs to get done to release funds for local reinvestment in better patient care and now is clearly the time to fire the starting gun.

“Today’s ‘reset’ sets out the agreed legal responsibilities of individual NHS bodies to live within the funding Parliament has decided should be available to the NHS this year. These individual accountabilities will be supplemented by the Sustainability and Transformation Plans now being developed in communities across England, which will set out the wider, shared action they will take together to unleash broader improvement on health, care, and financial sustainability to 2020.”

David Behan, Chief Executive of the Care Quality Commission, said: “Delivering high quality services that are designed around the needs of patients leads to better use of resources. The challenge for trust boards is to leverage this relationship between financial grip and good care – and through our inspections, we’ve seen this achieved in practice.

“For example, East Lancashire Hospitals NHS Trust, who have significantly reduced their planned deficit while making quality improvements that allowed them to move out of special measures, through a combination of harnessing new technology; rethinking their delivery of acute care and interventions designed to reduce admissions and readmissions.  And Wexham Park, whose rating moved from Inadequate to Good following its acquisition by Frimley – and has run on less money since the takeover.

“We’ll continue to highlight examples of trusts who are providing care that is both clinically and financially sustainable as we prepare with NHS Improvement to publish new ratings of how effectively trusts are using their resources to deliver high-quality services to patients. Although the context is increasingly challenging, the goal remains the same: good, safe care – the care that we would want for ourselves and our families.”

In an interview with HSJ on 13 July 2016, Jim Mackey said: “We are restoring good discipline, good governance and good processes that have continued to exist in our best providers.”



  1. Richard Curtis says:

    is there a comprehensive list of all the CCGs in Special Measures?

  2. WAEL ARAB says:

    One way to improve operational performance is to attend promptly to problems reported by patients. My experience suggests that CCGs, or at least mine, Camden, would rather spend more time taking people round in circles hoping they would give up, than the time that would be needed to mend that problem.

  3. kevin riley says:

    Jim Mackey is not revealing the true position when he reportedly states.said: “We are restoring good discipline, good governance and good processes that have continued to exist in our best providers.”

    Since the enactment of the Health And Social Care Act 2012 the only way the above can be achieved is by the Government passing primary legislation to restore the position to what it was before this Act came into force, that is before (in the then Government’s own words” the running of the NHS was removed from democratic control by the ceration of “independent” NHS Foundation Trusts””)

    This article once again conceals the legal reality that since the Health and Social Care Act 2012 each NHS Inundation Trust is “free from democratic control” not only from any pronouncements of NHS England (and it’s ever increasing and very expensive to the tax payer “off shoots”) but also from the Government (including Jeremy Hunt) and the Department of Health.

    There is nothing that any of the above can do (despite the statements in this article to the contrary) to force any of these independent bodies to behave in a particular way.

    The only remedy is to put the recalcitrant Trust into “special measures” which of itself cannot guarantee any improvement in the long term.

    In addition to the above, the reality is that immediate and significant “improvements/savings” could be made by reducing the appalling imbalance between the amount of money( circa 60% of total expenditure) each Trust spends on the salaries of it’s senior “managers” (from the Chief executives downwards) and other non front line service delivery staff as compared to what it spends on employing Doctors, Nurses and other front line service delivery personnel (circa 40%).
    Of course none of the organisations referred to above NHS England is going to promulgate this “improvement” as it would be like “turkeys voting for the retention of Christmas!!

  4. Paul Brickwood says:

    Where can I find the financial control totals for CCGs and Trusts which were published yesterday?

  5. Jim Hignett says:

    Surely removing the NHS targets is mea r ly an acmission of failure?