NHS organisations have been told to sort out their finances in preparation for making “very substantial efficiency savings” in 2010-11, when the health service’s three year settlement comes to an end.

The Operating Framework for the NHS in England 2009-10, announced by the Department of Health yesterday but only released onto its website this morning, says no NHS organisation will be allowed to plan for an operating deficit next financial year, unless they have an agreed recovery plan in place.

It also says organisations will be required to make 3% efficiency savings this year and “very substantial efficiency savings” the year after, to contribute to returning the economy to balance in the timescales identified in the Pre-Budget Report.

The Operating Framework says the cross-Government Operational Efficiency Programme will encourage the use of shared services, more collaborative procurement and more commercial use of buildings and other assets. It also says the DH is working with the Treasury on “specific, additional efficiencies” for the NHS that will be announced in the Budget.

Despite this, the Operating Framework says all primary care trusts will receive an average increase in their allocations of 5.5% this year, although some will do better than others under a new funding formula. And the National Programme for IT in the NHS is not identified as an area for cuts to be made.

The Operating Framework identifies a number of areas for increased informatics and IT spending, both to support more efficient working and the quality and choice agendas set out in the final report of Lord Darzi’s Next Stage Review of the NHS.

“In the past, informatics have too often failed to support adequately improvements in the quality of care,” it says, adding that there must be a focus on senior managers and clinicians “leading and owning in the informatics agenda” and improving the informatics capability of the whole NHS workforce, as outlined in the Health Informatics Review.

The Operating Framework sets out some specific IT initiatives in relation to quality. It says strategic health authorities will be expected to “agree a timeline” for implementing the NHS Summary Care Record with PCTs as commissioners.

It also says that “during 2009-10, we will migrate from the interim solution for performance sharing to a full solution using the Secondary Uses Service.”

On the choice front, it says that providers will be expected to “accept all clinically appropriate referrals online and ensure that sufficient slots are available to enable patients to book directly” – a measure aimed at improving slot availability on Choose and Book.

The Operating Framework says NHS Choices “will support the work of clinicians” in providing information to patients, and that PCTs should support the flagship site by “integrating it into local support and advice and encouraging GP practices to improve information about services.”

Despite its focus on finance and the Darzi agenda, the Operating Framework does not let up on information security. It says NHS organisations will be expected to achieve “a minimum of level 2 performance against the key requirements in the Information Governance Toolkit” and that NHS accounting officers must include details of data losses and confidentiality breaches in annual reports.

It also continues to emphasise the shift to local delivery of new IT systems. It says local informatics planning must deliver the “clinical five” systems identified by the Health Informatics Review into secondary care “as soon as possible” and “demonstrate how community services will be supported in a more integrated way with primary care and other local services.”

More information about this aspect of the Operating Framework is set out in detailed Informatics Planning Guidance, published alongside it.

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The Operating Framework for the NHS in England 2009-10 and supporting documents.