The Treasury has refused to sign off the NHS’s annual planning guidance in the wake of disruption from strikes and growing financial deficits, delaying its publication until the new year for only the second time in the last 15 years.

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Focus on productivity in 2024, NHSE tells boards

By Dave West 22 December 2023​

The Treasury has refused to sign off the NHS’s annual planning guidance in the wake of disruption from strikes and growing financial deficits, delaying its publication until the new year for only the second time in the last 15 years.

In lieu of issuing the guidance — which normally sets out detail of the service’s priorities and targets for the coming financial year — NHS England has issued a letter calling for a ”focus on recovering our core service delivery and productivity”, and saying boards will need to use a new set of national productivity metrics.

NHS England, and before that the Department of Health, have aimed to publish the document before Christmas to give the service time to prepare before the requirements come into force on 1 April. This has been achieved every year since 2007, except for 2018, when guidance was published in February to update what was meant to be the second year of a two-year 2017-19 planning round.

Local leaders were told last night that the core guidance would not be published today. 

Earlier this year, NHSE said it hoped to publish the 2024-25 guidance as early as autumn, but this plan was thrown off-course when large in-year deficits, and the government’s refusal to fund them, triggered a major in-year re-planning exercise.

This major reset of finance and delivery expectations in November meant NHSE and government were late starting to negotiate 2024-25 plans, and HSJ understands there was not time to agree headline delivery targets with the Treasury before the end of this year. Senior officials and ministers have also been focused on the latest round of junior doctors’ strikes.

NHSE had still hoped, until recent days, to publish a version of the planning guidance before Christmas which would set out headline objectives and priorities. This would have been followed up with a second document, setting detailed targets, in the new year.

But sources said the Treasury also objected to this plan, and instead NHSE is now aiming to publish full guidance in January. HMT was concerned that agreeing the first part of the guidance may prevent it securing the targets it wants to push for in the second. 

Elective recovery has received dedicated government funding and is typically a major focus, with government likely to be seeking reduction of the total waiting list.

Some sources claimed there was also disagreement about what programmes are still due to be delivered and when. The funding reset in November led to numerous ringfenced budgets which were intended to fund specific programmes – such as digitisation — being removed to reduce deficits.

One source familiar with discussions said: “It’s all about what government think is realistically deliverable within the financial envelope they’re providing. A pretty big gulf between them and NHSE. It’s not just limited to elective.”

Core delivery and productivity

NHSE sent a letter to local leaders on 22 December confirming the delay to the guidance because “discussions with government… remain live”.

Despite the delay, it said, local returns were expected to be due by the end of February. It stressed that systems will need to plan to balance their books in 2024-25, and said: “The coming year will require us to continue to focus on recovering our core service delivery and productivity.

“We will continue to target a reduction in the cost of temporary staffing. We will also work with ICBs and providers to agree a standard set of metrics that all executive teams and boards should use as a minimum to track productivity alongside service delivery.”

NHSE will during the year “agree a standard set of metrics that all executive teams and boards should use as a minimum to track productivity alongside service delivery”.

Other priorities will include:

• Maintaining the “increase in core urgent and emergency care capacity established in 2023-24”;
• Complete “agreed investment plans to increase diagnostic and elective activity and reduce waiting times”; and
• “Maximise the gain from the investment in primary care in improving access for patients, including the new pharmacy first service”;

Department of Health and Social Care said in a statement: ”The work to finalise planning guidance with NHS England in the new year is well advanced, with today’s letter enabling systems to start planning in earnest.

“We remain committed to the published recovery plans on urgent and emergency care, primary care access, and elective and cancer care, as key priorities for the NHS.”