Conclusion 9

Before the COVID-19 crisis, NHSE&I was working with NHS local bodies to develop the implementation plans for the NHS Long Term Plan. It intended to publish the implementation plan in December 2019 but that was delayed.14 In response to COVID-19, NHSE&I was given additional powers to coordinate services nationally. In March 2020, it suspended the implementation of the NHS Long Term Plan. It also moved funding for trusts from the activity-based tariff system before the crisis to one with fixed funding under block contracts until July 2020. These changes have resulted in a shift from moving more towards more decision making at a local level back towards a command and control 7 Committee of Public Accounts, NHS financial sustainability: progress review, Ninety-First Report of Session 2017–19, HC 1743, 3 April 2019; Committee of Public Accounts, Sustainability and transformation in the NHS, Twenty-Ninth Report of Session 2017–19, HC 793, 27 March 2018 8 C&AG’s Report NHS financial management and sustainability, Figure 5 9 C&AG’s Report NHS financial management and sustainability, paras 16, 3.2–3.8 10 Q43; C&AG’s Report NHS financial management and sustainability, para 3 11 NHS Providers’ written evidence; C&AG’s Report NHS financial management and sustainability, para 17 12 Qq 53, 60 13 Q74; C&AG’s Report NHS financial management and sustainability, para 20 14 NHS England and NHS Improvement, NHS Long Term Plan Implementation Framework, para 9.1, June 2019 10 NHS capital expenditure and financial management system coordinated directly by national bodies.15 NHS Providers noted that some of the measures introduced were welcomed by trust leaders. However, it warned that these measures were temporary, and that it is not yet clear how trusts will return to normal financial arrangements.16 NHSE&I told us that it is unlikely to go back to the previous regime after the crisis, that a move towards a more blended payment system is likely, and that it would set out its arrangements for the rest of the year in July.17 Supporting trusts with financial difficulties