Question to the Department of Health and Social Care:

To ask the Secretary of State for Health and Social Care, whether NHS organisations are expected to justify deviations from NHS England planning guidance where such guidance is non-mandatory.

The Medium-Term Planning Framework sets national delivery targets for integrated care boards (ICBs) and providers over multiple years. It sets performance expectations, based on nationally determined policies and budgets, and outlines enabling activities which will help ICBs and providers to deliver against said expectations.

Whilst the Medium-Term Planning Framework does not impose requirements as in legislation or the Government mandate, ‘must’ and ‘expected to’ language is used for priority targets and where a nationally consistent approach would be beneficial, for example to reduce unwarranted variation or to ensure that specific Government commitments are met. The word ‘should’ is used in cases where local flexibility is appropriate based on local determination, demographics, and/or prioritisation.

No internal guidance is issued to staff within NHS England specifically on the use of language within the Medium Term Planning Framework, but the text is checked to ensure consistency with the aforementioned principles. A suite of supporting materials, including technical guidance, webinars, and planning standards, are developed and shared across NHS England regions and the wider National Health Service system to support a clear understanding of the expectations and potential approaches to delivery set out in the Medium-Term Planning Framework.

The regionally led assurance process for planning returns allows NHS England to work with ICBs and providers to understand variance from the asks within the Medium-Term Planning Framework, where warranted.