At the beginning of every financial year, NHS England set out their clear expectations in operational planning guidance. Integrated care systems (ICS) use this guidance to produce their detailed plans for the year ahead, and agree those plans with NHS England, who will then hold them to account for delivering them. As part of in-year monitoring and reporting forecasts will be revised where necessary. On financial planning and forecasting, the Department in turn holds NHS England to account through regular senior official and ministerial meetings. We have taken steps to improve the level of transparency and detail of financial information from NHS England to provide appropriate scrutiny to ensure taut and realistic forecasts are provided to HM Treasury. We also review NHS England operational performance. For example, this year we have set up an Elective Oversight Board to improve our assurance over elective activity plans and forecasts.