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NHSE must be ‘realistic’ about ICS deficits

NHSE must be ‘realistic’ about ICS deficits
By Jess Hacker
12 January 2023

NHS England and the DHSC must be ‘realistic’ in setting targets for ICSs given their ‘substantial deficits’, Sir Chris Ham has said.

The bodies must show ‘realism about the time it will take’ to clear the ‘exceptional’ financial and operational pressures the new systems face, and must set out a ‘realistic set of medium-term objectives’.

Future updates to the NHS Long Term Plan must also consider this new context, he said.

It comes after NHS England’s December board papers revealed that ICSs have overspent by £651m in the first six months of the financial year against the NHS England revenue.

In a new report, Sir Chris Ham, co-chair of the NHS Assembly, warned that each ICS has inherited a significant deficit, with all 42 operating in a system that is missing key performance targets ‘by a wide margin’.

He pointed to the 2023/34 planning guidance – released over Christmas – which was noted for its relatively small number of national priorities, adding that future guidance should leave more scope for ICSs to plan locally.

‘This is important because changes to the superstructure of the NHS, such as the establishment of ICSs as statutory bodies and the proposals in the operating framework, may be a necessary condition of success in the new NHS but they are far from sufficient,’ he said.

The warning comes as part of a new report into accountability and autonomy in the NHS, marking key priorities ahead of the Hewitt review into the matter.

According to Sir Ham, that report – commissioned by the DHSC and led by former Labour health secretary Patricia Hewitt – must recommend that the number of national NHSE programmes be reduced, and ensure greater consistency in their operation.

It must also bring an end to bidding for funds tied to specific priorities.

Key priorities also include:

  • Expediting work on a shared outcomes framework to make sure it is co-produced between DHSC, NHSE and ICS leaders
  • Clarify the place of mutual accountability within the NHS oversight and enforcement frameworks
  • Undertake work to define a high-performing ICS
  • Recommend an operational development programme for the health and care system to support the development of collaboration
  • And ask the DHSC and NHSE to set out how they will align their work in future.

The Hewitt review into ICSs will consider reducing the number of national targets imposed on systems to cut through red-tape.

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