An end to annual planning
02/02/2016by Rob Findlay
The English NHS has (probably) been breaching the 18 week target since October. Quite simply, the waiting list has grown too big, and a longer queue means longer waits.
That is water under the bridge. The question now is how did it happen, and what can we do about it?
Is the problem a shortage of hospital capacity? Is it commissioners not buying enough? Is there not enough money in the system?
Yes. But underlying it all there is also a planning failure – a failure to know where the limits were, and to change course long before they were reached.
Historically, planning in the NHS has been part of the financial process. So every year, just before Christmas, new guidance gives the NHS instructions and deadlines for submitting its plans for the coming financial year.
This arrangement suits the financial timetable very well, but it doesn’t seem to deliver very good planning. So perhaps it’s time for a rethink.
The main purpose of planning should be to manage the delivery of local health services. In other words, to help ensure that the right staff will be in the right
facilities at the right time to deliver the right care to the right patients.
The main purpose is not to fit the financial timetable, or to keep NHS England happy (though both of those things can be achieved as useful side effects of real local planning).
So instead of focusing on the content of the plans it receives, perhaps NHS England’s main concern should be the process that created them.
Were those plans created as a one-off for this year’s planning round, as in most years? Or are they living plans: the latest refresh of the Trust’s regular monthly (or weekly) operational planning? Plainly the latter is much more likely to reflect real operational life, and to be acted upon by managers and clinicians.
There is, I think, a hint that NHS England may already be looking in this direction – the latest guidance particularly stresses “the skills to plan effectively”.
With real planning, we might actually start to manage our way out of trouble. But if we stick with the annual financially-driven cycle for our planning, I fear we we could end up firefighting ourselves into chaos.Return to Post Index