Recommendation 2

In addition, a lack of clarity persists on key areas of health and care spending that are likely to affect the NHS’s ability to deliver the Plan, including capital, education and training and social care. Even before the COVID-19 crisis, there were concerns that the NHS may struggle to deliver all its commitments in the Plan with the additional money available. In response to the crisis, NHSE&I suspended the implementation of the Plan and temporary changes to existing payment mechanisms for trusts. These changes have resulted in a shift from the earlier move towards more local devolved control, back to a command and control system coordinated by national bodies. Stakeholders tell us that this has helped to improve decision-making in many areas of working. It is unclear how this will develop and what impact this will have on local trusts, but NHSE&I thinks it unlikely that it will fully go back to the previous regime after the crisis. Recommendation: To ensure a sustainable NHS, the Department and NHSE&I should review how it directs its support to the most challenged parts of the NHS and how this will support a coherent plan to return to normal services and service improvements after the COVID-19 peak. This includes continuing to take on board our previous recommendations and the current ones in this report on improving financial and service sustainability across the NHS. The Department and NHSE&I should write to us by December 2020 to update us on its progress in this regard.