ICBs and other NHS organisations have been asked to prepare ‘credible integrated five year plans’ by NHS England in a new planning framework for 2026/27 to 2030/31 for the NHS in England.
These plans must be coordinated and coherent across organisations and ‘demonstrate robust triangulation’ between finance, quality, activity and workforce, it added. They will also be ‘refreshed annually’ and will build and align across time horizons, which are timeframes for planning.
The framework set out the key planning roles and responsibilities for ICBs, providers, regions, and national organisations, in order to help the development of the plans.
For ICBs, these are to:
- Set overall system strategy to inform allocation of resources to improve population health outcomes and ensure equitable access to healthcare.
- Lead system level strategic planning, ensuring effective demand management and optimal use of collective resources.
- Set commissioning intentions and outcome-based service specifications to enable providers to undertake effective operational planning aligned to national and local priorities.
- Convene and co-ordinate system-wide planning activities, for example, pathway redesign, neighbourhood health, fragile services, capital and estates.
- Work closely with region on planning activities where a cross-system or multi-ICB response is required.
- Co-ordinate system response to nationally determined NHS planning requirements, working with region and providers.
Regions have been told to support ICBs to ‘create the conditions’ for effective integrated planning across the region, while providers will work with ICBs to ensure plans ‘reflect the agreed commissioned activity levels’, and that they support the delivery of the best outcomes for patients.
Under the national roles and responsibilities, there is a requirement to set the strategic direction and national standards for the NHS, as well as delivering centrally developed resources, such as analytical tools.
NHS England added that there would be two phases to the planning process. The first of which will establish clear roles and responsibilities as well as multidisciplinary planning teams to coordinate the planned activities. The second will then fully develop plans which will be signed off by boards (see box 1 below for details).
Box 1: ICB core activities in phase one and two
ICB core activities in phase one – setting the foundations:
- In collaboration with providers and partners perform a refresh of the clinical/organisational strategy as required to ensure they are updated to reflect changes in national policy (for example, the 10 Year Health Plan) or local context.
- Review organisational improvement capability.
- Establish appropriate governance structures and agree responsibilities and ways of working to support the integrated planning process, including engagement with patients and local communities. This should include working with providers.
- Assess population needs, identifying underserved communities and surfacing inequalities, and share with providers.
- Review quality, performance and productivity of existing provision using data and input from stakeholders, people and communities.
- Develop initial forecasts and scenario modelling for demand and service pressures.
- Generate actionable insights to inform service and pathway design with providers.
- Create outline commissioning intentions for discussion with providers.
ICB core activities in phase two – integrated planning:
- Develop an evidence-based five-year strategic commissioning plan to improve population health and access to consistently high- quality services.
- Bring together neighbourhood health plans into a population health improvement plan in discussion with people, communities and partners.
- Iterate initial forecasting and scenario modelling for demand and service pressures.
- Finalise commissioning plans to inform provider plan development.
- Undertake Quality and Equality Impact Assessments to support informed decision-making through the planning process.
- Ensure improvement resources are aligned to the priority areas of the plan.
The framework said: ‘Having an aligned, integrated plan is not enough – the plan must also be credible, deliverable and affordable. Credibility means the plan’s assumptions and targets are evidence-based and convincing to stakeholders (including regulators and the public).
‘Deliverability means that the plan can realistically be executed with the available resources and operating environment. Affordability means the plan’s financial assumptions are sustainable and align with available funding and budgetary limits.
‘Executives and boards are expected to rigorously test the plan before finalising it using robust assurance processes. This includes formal challenge sessions during the plan’s development, to critically test assumptions and proposals, and request revisions if needed.’
The framework also set out the four different types of planning documents that will be used within the NHS. These include the five-year strategic commissioning plans, by ICBs, and the five-year integrated delivery plans, by NHS trusts and foundation trusts.
Also included were neighbourhood health plans ‘drawn up by local government, the NHS and its partners at single or upper tier authority level under the leadership of the Health and Wellbeing Board’, and national plan returns (see box 3 for details).
It comes as NHS England is in talks with the Government over funding ICB redundancies, according to its chief executive Sir Jim Mackey.
Box 2: Four planning documents used in the NHS going forward
Five-year strategic commissioning plans (ICBs)
Describes how, as a strategic commissioner, an ICB will improve population health and access to consistently high–quality services across its footprint. We will work with ICBs to develop specific guidance. As a minimum, we expect that plans will:
– Set out the evidence base and overarching population health and commissioning strategy,
– Bring together local neighbourhood health plans into a population health improvement plan (PHIP), including how health inequalities will be addressed,
– Describe new care models and investment programmes that maximise value for patients and taxpayers aligned to 10 Year Health Plan,
– Demonstrate how the ICB will align funding and resources to meet population needs, maximise value, and deliver on key local and national priorities,
– Describe how the core capabilities set out in the ICB blueprint will be developed.
ICBs will be expected to refresh these plans annually as part of a rolling five-year planning horizon for the NHS.
Five-year integrated delivery plans (NHS trusts and NHS foundation trusts)
Demonstrates how the organisation will deliver national and local priorities and secure financial sustainability. We will work with providers to develop specific guidance. As minimum, we expect that plans will:
- Set out the evidence base and organisation’s strategic approach to:
– Improving quality, productivity, and operational and financial performance
– Meeting the health needs of the population it serves and how this approach contributes to delivering the overall objectives of the local health economy
– Describe the actions that will support delivery of the trust’s objectives, including key service development and transformation schemes and how these will impact quality and support operational and financial delivery
– Summarise how the underpinning capabilities, infrastructure and partnership arrangements required to deliver the plan will be developed e.g. workforce skills, digital capability, and estate.
Providers will be expected to refresh these plans annually as part of establishing a rolling five-year planning horizon for the NHS.
Neighbourhood health plans
These will be drawn up by local government, the NHS and its partners at single or upper tier authority level under the leadership of the Health and Wellbeing Board, incorporating public health, social care, and the Better Care Fund. The plan should set out how the NHS, local authority and other organisations, including social care providers and VCSE, will work together to design and deliver neighbourhood health services. DHSC will publish separate guidance to support their development.
National plan returns
We will engage with ICBs and providers on the specific requirements for the national plan returns. Five-year organisational plans will be expected to fully align with and support numerical returns. The existing set of annual finance, workforce, activity and performance templates will be redesigned and streamlined to better support integrated planning. There will be separate returns from ICBs and trusts rather than a single-system return. ICBs and providers will need to work together to ensure that these are fully aligned.
Source: NHS England
