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Letters show how CCGs directed to up activity plans

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Letters seen by LGC’s sister title Health Service Journal reveal how NHS England ordered clinical commissioning groups to change their contracts with acute providers to reflect an assumption that hospital activity would grow this year.

  • Letters obtained by HSJ show how NHS England ordered CCGs to increase planned activity in acute contracts
  • CCGs criticise the “top-down approach”
  • Plans now contradict better care fund intention to cut emergency admissions


Correspondence, obtained under the Freedom of Information Act, shows how the national organisation told CCGs in the South first to revise upwards their planned 2015-16 activity, and to reopen contracts to bring them into line with the new plans.

CCGs were also required to explain what they were doing to ensure hospitals could deal with the increased demand, including paying for extra NHS or independent sector capacity.

The first of the letters, both from NHS England regional director for the south Andrew Ridley, told all CCGs which had seen emergency admissions grow in 2014-15 to plan for a rise of at least 3.6 per cent this year.

Andrew Ridley

Andrew Ridley told CCGs with increased emergency admissions in 2014-15 to plan for a rise of 3.6 per cent this year

A subsequent letter shows that, as a result, the region’s total activity plan moved from a cut in emergency admissions and a very small increase in elective activity, to growth of 2.7 per cent rise in emergency admissions and 3 per cent in electives.

The plan for increased emergency admission growth contradicts the aims of the better care fund, which health secretary Jeremy Hunt has said will save more than £250m in 2015-16 through a 3.07 per cent year on year fall in emergency admissions.

In one letter Mr Ridley, who led the better care fund assurance and planning process last year, asked CCGs to change acute contracts. He said: “The current variances between CCG plans and contracts means that providers may not be able to make appropriate provision for the year ahead to meet the expected commissioner demand and secure the resources required to deliver the capacity in a timely and cost effective way.”

Another added: “I recognise that there are some providers with capacity issues and these providers may not agree to a contract that reflects the volume of activity in the CCG plan.

“In these circumstances, CCG accountable officers should explain [to NHS England] the volume of activity in the contract, the gap, and most importantly, the actions they are taking to resolve the issue and secure additional capacity either with NHS or IS providers.”

HSJ understands similar letters were sent to CCGs elsewhere in the country during May and June.

An NHS Clinical Commissioners spokeswoman told HSJ it has had several conversations with NHS England about the “burden of assurance” and the “top-down approach” being taken in some parts of the country.

The organisation’s co-chair Steve Kell said the instructions were damaging investment in non-acute care.

He said: “There is a real danger that one year into the NHS Five Year Forward View the NHS continues in the wrong direction. We risk repeating the mistakes of the past by simply increasing funding going into hospitals.”

Despite NHS England’s directions to CCGs, the Department of Health is understood to still be confident the better care fund will result in reduced emergency admissions in 2015-16, leading to financial savings.

NHS England did not respond to inquiries. Speaking at the organisation’s board meeting last month, chief executive Simon Stevens said it had told CCGs to change plans in order to “strike a pragmatic balance between assuming a continuation of current demand trends versus factoring in the expected impact of CCGs’ ambitious new programmes to moderate demand growth”.

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