NHS England and NHS Improvement: Annual Assessment 2019-20

Today, I am laying before Parliament my annual assessment of the NHS commissioning board (known as NHS England) for 2019-20.

Covid-19 has presented an unprecedented challenge, the scale of which the NHS has not seen in its 72-year history. I would like to begin by giving my utmost thanks and appreciation to all colleagues throughout the NHS for their dedication and hard work responding to the virus.

My assessment of NHS England and NHS Improvement’s (NHSE/I) performance for 2019-20 reflects the impact these challenges have had on the health service and differentiates between performance before the pandemic took hold and the subsequent impact managing the virus has had on delivery. To this end, I have defined performance pre-covid-19 as the period April 2019 to end January 2020. Evidence from this period has been used to make a reasonable assessment of where performance would have been had covid-19 not happened.

2019-20 was a transitional year for the NHS, that saw NHSE/I embed the first phase of delivery against the NHS long term plan. NHSE/I has worked closely with local health systems to develop robust, system and local-level implementation plans. In 2020-21 these plans will need to be revised to reflect possible new and longer-term demands caused by covid-19 and to account for the Government’s 2019 manifesto commitments. To ensure these plans are workable NHSE/I must ensure disciplined financial management across all organisations. I am therefore pleased to see most NHS providers reporting a year-end position that is equal to or better than their agreed control totals.

To ensure performance targets are appropriate and help improve clinical quality and outcomes, NHSE/I has field tested proposals in urgent and emergency care, routine elective care, cancer and adult and children’s mental health as part of the clinically led review of NHS access standards. The impact of covid-19 has delayed the final evaluation report and I expect NHSE/I to continue to work with wider Government and local NHS organisations to produce evidence-based approaches. An increase in demand for services in 2019-20 pre-pandemic has meant that performance targets on NHS constitutional standards were not on track to be met by the end of the year. Between April 2019 and January 2020, demand for urgent investigation of possible cancer and emergency admissions via A&E increased by 8% and 3.5% respectively, compared to the same period last year, making it harder for the NHS to treat patients within the agreed targets. Key to managing demand in the system is ensuring a steady flow of patients through to the point at which they can be safely discharged. Despite great efforts in both health and social care, the average delayed transfer of care (DTOC) figure of 4,000 or fewer delays remains challenging and the trajectory up until January 2020 was 5128 leaving a cumulative target of 1,182 beds to be delivered.

Another key element of the NHS long term plan was publication in June 2019 of NHSE/I’s interim people plan that was reinforced in August 2020 with the “We are the NHS: People Plan for 2020-21—action for us all”. The publication of the overarching NHS people plan will need to account for new workforce demands and costs due to the pandemic as shortages remain a critical risk to service recovery. It is also critically important that we have rigorous plans in place to deliver the additional 50,000 nurse places that the Government promised to deliver in this Parliament. I am also grateful that NHSE/I has taken the lead in supporting members of our workforce who are most vulnerable and provided an enhanced staff health and wellbeing offer, including targeted support for our BAME colleagues and, where possible, offering opportunities for flexible and remote working.

I am pleased to see NHSE/I support the Government’s health and social care pledges set out in the 2019 manifesto. Great progress has been made on capital in 2019-20, which was underpinned by the health infrastructure plan (HIP), published in September 2019. The Government are committed to building 40 new hospitals, and the NHS has already made significant progress in developing these plans to deliver world-class care in world-class facilities. Similarly, the NHS has pressed ahead with delivering the 20 hospital upgrades announced by the Prime Minister in August 2019. I am assured NHSE/I has committed to work with the Government to improve public confidence in hospital food and commend them for supporting the commitment to abolish hospital parking fees for those patients and families in greatest need.

Looking forward, I am pleased to see NHSE/I use evidence from responding to covid-19 to reduce barriers and improve the way services are delivered. The pandemic has also brought to light the burden placed on the NHS by the interoperability of systems and the need for more effective information sharing between care settings and organisations, as well as between professionals and the public, to enhance health outcomes and quality of care. I am therefore eager to see the implementation of the technology standards set out in the “Future of Healthcare” to better integrate information flows.

The NHS remains this country’s most valued public service, an institution that is there for every family, everywhere, at the best of times and at the worst. In light of covid-19, the Government want to continue to ensure that the NHS has the space, certainty and funds to deliver a transformative plan that will ensure patients benefit from a ground-breaking health service into the next decade.

We will continue to work closely with NHSE/I to help them deliver this ambition, address the challenges that lie ahead and provide a sustainable and efficient health service with quality, transparency and safety at its heart.

Copies of my annual assessment and NHSE/I’s annual report will be available from the Vote Office and Printed Paper Office.

[HCWS741]