Asked by: Baroness Shephard of Northwold (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government why NHS England have told commissioners that they cannot utilise non-recurrent reserves held in their funding allocation to mitigate future potential risks; and what are the reasons for putting commissioners into financial turnaround processes when they have sufficient reserves available to them to maintain their financial duties.
Answered by Lord Prior of Brampton
The National Health Service leadership bodies have set out their own plan for delivering financial sustainability for the NHS, in the Five Year Forward View (October 2014) and Strengthening Financial Performance and Accountability in 2016/17 document (July 2016), a copy of which is attached.
It is clear that there is a significant financial challenge across the NHS, due to the increasing demand for health services as a consequence of the ageing and growing population, new drugs and treatments and safer staffing requirements. This is why we are investing the additional £10 billion the NHS has said it needs to implement its own plan for the future.
It is absolutely sensible for reserves to be created as part of this plan, to help deliver financial sustainability and insulate the global health economy from financial risk. Decisions must be made at a macro level on the best and most efficient use of resources, to maximise benefit to front-line healthcare services.
All clinical commissioning groups (CCGs) must comply with a financial framework, devised to support the delivery of this plan. Any CCG not doing so, will be required to devise a financial recovery plan as part of measures to improve the financial performance of that organisation.
Asked by: Baroness Shephard of Northwold (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government whether Clinical Commissioning Groups (CCGs) are penalised for breaches of targets set out in the NHS Constitution and pledges on waiting times, and Acute Hospital Trusts (AHTs) are not penalised for the same breaches; and if so, whether this represents differing treatment of CCGs and AHTs by NHS England.
Answered by Lord Prior of Brampton
National Health Service clinical commissioning groups (CCGs) are not directly penalised for each breach of NHS Constitution waiting time commitments, or the associated operational standards. However, access to Quality Premium scheme funding, which CCGs can earn in addition to their normal allocations for achieving specific improvements in care or outcomes, is partially dependent on each CCG’s performance against waiting times standards. More broadly, NHS England is supported by legislation in exercising formal powers of direction if it is satisfied that a CCG is failing or at risk of failing to discharge its functions. The NHS Standard Contract provides for financial sanctions against acute hospital trusts for breaching waiting time operational standards.
NHS England issues planning guidance annually, the latest of which is NHS Operational Planning and Contracting Guidance 2017-2019. This sets out the waiting time standards, other operational standards and quality requirements that providers of NHS healthcare services are expected to meet in order to deliver the rights and pledges in the NHS Constitution. Copies of the Guidance and the NHS Constitution are attached.
These requirements are set out in the NHS Standard Contract that must be used by CCGs for all contracts with hospital providers of NHS healthcare services. The Contract sets out the consequences of breaches of the waiting time standards and other requirements by hospital providers. For waiting time standards, this consequence is in the form of a financial sanction.
However, from 2016-17, the operation of contractual sanctions for poor performance against waiting time standards has been suspended where a hospital provider is receiving funding from the Sustainability and Transformation Fund (STF), and meets certain other specified conditions, including the agreement of performance trajectories with NHS Improvement and NHS England. These arrangements are arranged at avoiding ‘double jeopardy’ for hospital providers within scope of the STF. If they fail to achieve their agreed performance trajectories, these hospital providers will face withdrawal of an element of their STF funding by NHS Improvement, but will not face application of the normal contractual sanctions by their commissioners.
Asked by: Baroness Shephard of Northwold (Conservative - Life peer)
Question to the Department of Health and Social Care:
To ask Her Majesty’s Government, in the light of the costs resulting from the employment of junior doctors on temporary contracts, how many appointments of junior doctors on temporary contracts lasting more than six months have been approved by NHS England in the last year for which figures are available; and what are their reasons for approving those appointments.
Answered by Lord Prior of Brampton
In July 2015, the Secretary of State announced a series of measures to bring trusts’ spending on agency staff under control. Trusts are using these measures to negotiate lower rates and secure a better deal for taxpayers. In 2015-16 the National Health Service spent £300 million less than projected on agency staff. Further savings are forecast for the current financial year.
Individual trusts have the freedom to apply independent processes for approving the appointment of locum staff. Individual appointments do not require central approval by NHS England.
The compliance data that trusts report to NHS Improvement does not include detail that would enable the tracking of grade or length of employment. However, on 7th October 2016, the Chief Executive of NHS Improvement wrote to trusts asking them to publish anonymised lists of agency workers who have been employed at trusts for more than six months. This information will be published by trusts later this year, but will not be broken down by grade.