riorities for the NHS during the year ahead as laid out in the operating framework remain largely unchanged from previous years, but the NHS needs to start planning for a tough financial climate ahead, the DH says.

The Operating Framework for 20010/11 has reiterated the five key priorities for the NHS which will help it deliver high-quality, patient-centred care, focusing on: better cleanliness and slashing hospital-acquired infection rates; better access to both primary and secondary care services; improving public health and reducing inequalities; improving the patient experience and staff engagement; and becoming better equipped to deal with state of emergencies such as the flu pandemic.

While these priorities have now been set in place for five years, the DH has stressed that the NHS must start planning for how to deliver on these targets “in the context of tougher economic circumstances”, in which the impact of budget constraints will be magnified by an increasing demand on services.

The next year is certainly pivotal for the NHS, noted NHS chief executive David Nicholson. While the chancellor has promised to increase spending on frontline services in line with inflation between 2011 and 2013, efficiency saving of £20 billion must be made by 2013/14 in order to redirect funds into delivery quality improvements when budgets are squeezed more tightly. “We need to use our growth in 2010/11 to put into effect the changes that we know will deliver the most benefits to patients in the future,” he said.

Nicholson also called for a “relentless focus” on three things to bring about this change: “Firstly, improving quality whilst improving productivity, using innovation and prevention to drive and connect them. Secondly, having local clinicians and managers working together across boundaries to spot the opportunities and manage the change. And thirdly, to act now and for the long term”.

While many of the themes in the Operating Framework are old hat, it also sets out a number of “new and powerful shifts in national policies” and to help the health service to rise to the challenges ahead. Perhaps most significantly, big changes have been made to the payment system for hospitals, forging a closer link between pay and patient experience. “Best practice” tariffs have also been introduced to ensure that prices paid reflect the highest quality care, and primary care trusts will be handed the power to withdraw payments when care is below par.

“This year’s operating framework provides a further reminder of the scale of the efficiency savings the NHS needs to make if it is to survive the biggest financial challenge it has faced in a generation,” commented Steve Barnett, chief executive of the NHS Confederation, and he said the “requirement to reduce management costs over four years reflects the need for every part of the NHS to make its contribution. Doing this in a measured way to avoid extensive redundancy costs and deliver real savings will be important”.