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In a new document published on 24 December 2021, NHS England has detailed its priorities and operational planning guidance for 2022/23.

For 2022/23, NHS England will focus on restoring services, meeting new demands and clearing the backlog caused by the coronavirus pandemic. To ensure these goals are met, NHS organisations are asked to take pandemic learnings into account to ensure new models of care are rapidly introduced that harness the power of digital technologies.

The document continually reinforces the importance of partnership working and ICSs in achieving the NHS’ priorities for the next year. It says that the Health and Care Bill, which intends to put ICSs on a statutory footing and create integrated care boards as new NHS bodies, is currently being considered by parliament.

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A new target date of 1 July 2022 has been agreed for statutory ICS arrangements to take effect and integrated care boards (ICBs) to be legally and operationally established. This replaces the previously stated target date of 1 April 2022.

In the opening letter by NHS Chief Executive Amanda Pritchard, she states: “The objectives set out in this document are based on a scenario where COVID-19 returns to a low level and we are able to make significant progress in the first part of next year as we continue to rise to the challenge of restoring services and reducing the COVID backlogs.

“Building on the excellent progress seen during 2021/22, this means significantly increasing the number of people we can diagnose, treat and care for in a timely way. This will depend on us doing things differently, accelerating partnership working through integrated care systems (ICSs) to make the most effective use of the resources available to us across health and social care, and ensure reducing inequalities in access is embedded in our approach.”

NHS England will focus on the following priorities for 2022/23:

  1. Invest in the workforce
  2. Respond to COVID-19 more effectively
  3. Tackle the elective care backlog
  4. Improve the responsiveness of urgent and emergency care
  5. Improve timely access to primary care
  6. Enhance services for people with learning disabilities
  7. Continue to develop approach to population health management, prevent ill-health and address health inequalities
  8. Harness the power of digital technologies to transform the delivery of care and patient outcomes
  9. Use resources effectively
  10. Establish ICBs and collaborative system working

Below, AT Today has detailed some of the key points for each NHS England priority, looking at how services will be restored and improved for the year ahead.

Read the document in full here

1. Invest in the workforce

NHS England emphasises the importance of making the NHS a better place to work for all staff members.

The guide says that employee retention can be achieved through a focus on flexible working, early/mid/late career conversations and enabling staff to understand their pensions. It adds that employee attendance should be improved by investigating the causes of non-COVID absences and better supporting staff to return to work.

In 2022/23, NHS England will further look to accelerate the introduction of new roles, development of the workforce required to deliver multidisciplinary care closer to home (including developing discharge to assess models), and expansion of international recruitment.

2. Respond to COVID-19 more effectively

“Delivery of the vaccine programme is expected to remain a key priority as we look ahead to 2022/23 and systems are asked to plan to maintain the infrastructure that underpins our ability to respond as needed,” the guide reads.

To help respond to the COVID-19 pandemic more effectively, NHS England is now rolling out a number of new treatment options for non-hospitalised NHS patients at greater risk from the virus, including neutralising monoclonal antibodies and oral antivirals. These treatments are in addition to the vaccines and do not intend to replace them. They are designed to reduce the risk of hospitalisations and deaths.

During the pandemic, NHS England created 90 specialist long COVID clinics to assess, diagnose and help people recover from long COVID, as well as 14 paediatric hubs to provide expert advice to local services treating children and young people.

As there are variations across systems in referral rates, access to clinics and waiting times, NHS England is now asking systems to increase the number of patients referred to post-COVID services and seen within six weeks of referral, and decrease the number of patients waiting longer than 15 weeks to enable their timely placement on the appropriate management or rehabilitation pathway.

3. Tackle the elective care backlog

Every system is required to develop an elective care recovery plan for 2022/23, setting out how the first full year of longer-term recovery plans will be achieved. NHS England says that elective care backlogs can be tackled through increasing capacity, prioritising treatment and transforming delivery of services.

The national service has set an ambitious goal to deliver around 30 percent more elective activity by 2024/25 than before the pandemic. It is also asking systems to eliminate waits of over 104 weeks as a priority and maintain this position through 2022/23 (except where patients choose to wait longer).

4. Improve the responsiveness of urgent and emergency care

NHS England’s focus for 2022/23 will be on continuing reforms to community and urgent and emergency care to deliver safe, high-quality care by preventing inappropriate attendance at emergency departments (EDs), improving timely admission to hospital for ED patients, reducing length of stays, and restoring ambulance response times.

An essential requirement is to increase the capacity of the NHS by the equivalent of at least 5,000 G&A beds and return, as a minimum, to pre-pandemic levels of bed availability, according to the guidance.

Due to increasing pressure on acute services, NHS hospitals are being requested to develop detailed plans to maximise the rollout of already-successful virtual wards to deliver care for patients who would otherwise have to be treated in hospital. These plans should be developed across systems and provider collaboratives, rather than individual institutions, based on partnership between secondary, community, primary and mental health services. Systems should also consider partnerships with the independent sector where this will help grow capacity.

By December 2023, NHS England expects systems to have completed the comprehensive development of virtual wards towards a national ambition of 40–50 virtual wards per 100,000 population.

5. Improve timely access to primary care

The document reads: “We expect systems to maximise the impact of their investment in primary medical care and PCNs [primary care networks] with the aim of driving and supporting integrated working at neighbourhood and place level.

“Systems are asked to look for opportunities to support integration between community services and PCNs, given they are an integral part of solutions to key system challenges that require a whole system response, including elective recovery and supporting more people in their own homes and local communities. Systems should also consider how community pharmacy can play a greater role in local plans as part of these integrated approaches.”

6. Enhance services for people with learning disabilities

Alongside ensuring that patients get the mental health support they need, the document mentions that the needs of people with learning disabilities and autism also need to be met.

It says that the pandemic has exacerbated the significant health inequalities experienced by people with a learning disability and autistic people. With healthcare services continuing to go digital, NHS England emphasises that systems should make reasonable adjustments for those with learning disabilities and autism, as well as consider face-to-face appointments for this group of people.

7. Continue to develop approach to population health management, prevent ill-health and address health inequalities

NHS England wants to put the focus on managing and preventing health conditions, so that people play a proactive role in promoting good health. ICSs will also take a lead role in tackling health inequalities.

The guide says that the safe and effective use of patient data is key to achieving these goals.

NHS England explains: “By April 2023, every system should have in place the technical capability required for population health management, with longitudinal linked data available to enable population segmentation and risk stratification, using data and analytics to redesign care pathways and measure outcomes with a focus on improving access and health equity for underserved communities. Systems are encouraged to work together to share data and analytic capabilities.”

8. Harness the power of digital technologies to transform the delivery of care and patient outcomes

The document states that the use of digital technologies transformed the delivery of care during the pandemic and that these strong foundations should continue to be built upon. In practice, this means better outcomes for patients, better experience for staff and more effective population health management.

Acute, community, mental health and ambulance providers are required to meet a core level of digitisation by March 2025, in line with the NHS Long Term Plan commitment. By March 2022, systems should develop plans that set out their first year’s priorities for achieving a core level of digitisation across all these settings, NHS England underlines.

9. Use resources effectively

With the NHS funding announcements from the Spending Review 2021 (SR21), NHS England wants to ensure the investments are used to fully restore core services and clear elective backlogs.

Financial and contracting frameworks are expected to evolve to enable systems to take the appropriate funding decisions for their populations, which will help restore services.

The 2022/23 financial and contracting arrangements include a continued focus on integration of services to support the transition for future delegations. For those services that continue to be commissioned by NHS England in 2022/23, mechanisms to strengthen joint working with ICBs will be established.

10. Establish ICBs and collaborative system working

Clinical Commissioning Group (CCG) leaders and designate ICB leaders should continue with preparations for the closure of CCGs and the establishment of ICBs, working toward the new target date of 1 July 2022, the document outlines. Systems should ensure they have clear and effective plans for local communications and engagement with the public, staff, trade unions and other stakeholders regarding the changes in collaborative working and responsibilities.

NHS England adds: “The Health and Care Bill before Parliament will require each ICB to publish a five-year system plan before April each year. This plan must take account of the strategy produced by the integrated care partnership (ICP), and the joint strategic needs assessments and joint health and wellbeing strategies produced by the relevant health and wellbeing board(s).”

ICBs should ensure that their five-year plans, which are expected to be delivered in March 2023, reflect the national ambitions and priorities for the NHS; improve outcomes in population health and healthcare; tackle inequalities in outcomes, experience and access; enhance productivity and value for money; support broader social and economic development; and take account of the responsibilities that they will be taking on for commissioning services that are currently directly commissioned by NHS England.”

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