Two-thirds of ICSs are expected to miss NHS England’s elective activity target this year, with those systems set to lose 75% of the attached funding, the National Audit Office (NAO) has warned.
In its major report into managing NHS backlogs, published this morning (17 November), the NAO said the overall level of elective activity has remained below pre-pandemic levels and is below NHS England’s trajectory for reaching 129% of the 2019-20 level by 2024-25.
But more than half of ICSs have signalled they are not expecting to meet the initial target, which requires them to meet 104% of the 2019-20 level by 2022-23.
Measured as ‘value-based activity’, NHS England’s metric for determining activity considers the different costs of different types of elective activity, including inpatient and outpatient follow-up.
At the start of the year, NHS England allocated up to £2.3bn funding to ICSs for elective recovery, with any ICS falling short of the 104% target losing 75% of its elective recovery funding.
Those which exceed the target receive an additional 75% of the tariff value for the additional activity.
Guidance published in April this year set out that system plans would only be signed off by their region if they demonstrated they would meet or exceed that initial target.
That guidance said: ‘Activity plans must deliver more than 104% of pre-pandemic value weighted elective activity levels nationally and systems and providers need to agree plans that reflect this ambition, including going further for those that are able to.
‘Each system and trust must understand where waiting list challenges exist locally and what
is driving them, and ensure that it has a plan to deliver improvement in 2022/23.’
Based on the plans submitted, those 26 expecting to fall short will see an average activity level of around 101%, the NAO said.
‘This would mean that much of the £2.3bn could end up being clawed back by NHSE, with uncertainty over how it would then be spent,’ it added.
It comes as ICSs prepare for what is anticipated to be one of the wort winters on record.
The NHS has said it will set up 24/7 ‘war rooms’ at ICB level which will constantly track beds and attendances, taking stock of all activity and performance for the first time.