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Take a look at a selection of our recent media coverage:
4th April 2024
Every hospital trust will be required to have ‘a designated lead for the primary-secondary care interface’ and integrated care boards asked to ‘regularly review progress’, according to NHS England’s newly published ‘2024/25 priorities and operational planning guidance’.
Delayed since December due to funding discussions, the guidance sets an overall priority for the NHS in England over the next 12 months as the ‘recovery of core services and productivity following the Covid-19 pandemic’ continues.
According to the guidance, streamlining the patient pathway by improving the interface between primary and secondary care is ‘an important part of recovery and efficiency across healthcare systems’.
By introducing a designated lead for the primary-secondary care interface, it is hoped that trusts will deliver on the four key areas set out in the access to primary care recovery plan and endorsed by the Academy of Medical Royal Colleges: onward referrals, complete care (fit notes and discharge letters), call and recall and clear points of contact.
Commenting on this interface, David Wiliams, head of policy and strategy at NHS Providers, said his organisation is already ‘seeing the advantages’ of leaders of NHS trusts and local health systems ‘working closely with primary care partners to improve how they cooperate to benefit patients’.
And he said this was ‘playing out in a variety of ways as system working matures and care pathways are being transformed, often at a very local level’.
He added: ‘Designated primary care leads will be welcome support in the drive to achieve closer working, but given the pressure of day-to-day operations, trusts and primary care providers will need national support to focus on the long-term to deliver further improvements.’
Improving emergency department waiting times compared to 2023/24 is another core focus of the planning guidance, with a target for A&E staff of a minimum of 78% of patients being seen within four hours in March 2025.
The Royal College of Emergency Medicine (RCEM) had described a previous target of 76% of patients being seen within four hours as ‘unambitious’. On the latest target, RCEM president Dr Adrian Boyle said the ‘small percentage improvements in four-hour access performance are difficult to endorse when there are so many people waiting for 12 hours or longer’.
He also highlighted the incentive scheme for major emergency departments that ‘achieve the greatest level of improvement’ and/or are able to see 80% of patients within four hours outlined in the planning guidance as being ‘potentially divisive’ and uneconomical.
‘We would prefer a quarterly approach to incentivise improved performance, perhaps using the Commissioning Quality Incentive payment system,’ he said.
Dr Boyle did, however, welcome the planning guidance focus on bed occupancy, saying: ‘It is critically important to reduce the dangerous occupancy levels we are currently seeing.’
Dr Boyle noted NHS England data showing that total bed occupancy levels in hospitals across the country reached 95.1% on 20 March 2024.
He said: ‘Overcrowding and patients who are technically ready to go home but haven’t got the right care provision in place, is really adding to the delay problems faced by ambulance staff and we need to ensure that staff in Emergency Departments are able to offer patients the care that they deserve.
“Bed occupancy is still too high and seems to be increasing which is not a good sign that any improvement in that area is forthcoming.’
Nevertheless, the planning guidance outlines an ambition to reduce the number of patients who are still in hospital beyond their discharge-ready date, as well as the length of delay.
It is hoped that continuing to develop services that shift activity from acute hospital settings to settings outside an acute hospital for patients with unplanned urgent needs, supporting proactive care, admissions avoidance and hospital discharge will also be of benefit, the guidance said.
Other priorities outlined in the planning guidance include reaching a 77% faster diagnosis standard (FDS) target for cancer this year as an interim step toward meeting the target of 80% by March 2026, reducing Category 2 ambulance response times to an average of 30 minutes across 2024/25, as well as improving the working lives of all staff and increasing staff retention and attendance through systematic implementation of all actions and best practice made available through the NHS retention hub.
Acknowledging that many of these ambitions will be ‘stretching’ and require ‘a relentless focus on improvement, fewer delays and unnecessary processes’, NHS chief executive Amanda Pritchard said the guidance ‘should be seen as the floor, rather than the ceiling, of our collective ambition to be a better and more responsive employer’.
Royal Colleges and NHS partner organisations have expressed concerns about how this will work in practice.
Looking at the guidance as a whole, Matthew Taylor, chief executive of the NHS Confederation, called the ambitions ‘very challenging for the health service’.
‘We are concerned that the NHS is entering the new financial year in a worse underlying position, with the risk of further strike action over the next six months… compounded by the financial crisis facing many local councils.’
He also criticised the timing of the publication, saying that while the Confederation understood the impact the wider political context is having on long term decision making, ‘we need to get back to a position where the planning guidance is released months and not days ahead of the new financial year’, and that ‘this short-term approach risks holding back the NHS and with it, the wider health and care system’.
Also picking up on the strikes, Sally Warren, director of policy at The King’s Fund, warned that the plan is ‘built upon an assumption that there will be no industrial action throughout the year despite the fact negotiations are still ongoing’.
She added: ’This means it’s quite possible the Government will need to step in to find additional funding if industrial action continues or new pay deals are agreed, assuming it wants the NHS to deliver on the expectations and targets that have been set out.’
1st November 2023
Around 400,000 patients who have been waiting the longest for elective treatment will be offered the opportunity to travel to a different hospital to be treated sooner, NHS England has said.
Any patient who has been waiting longer than 40 weeks for treatment and who does not have an appointment within the next eight weeks will be contacted by their hospital.
It comes after analysis by the Health Foundation indicated that the waiting list for elective NHS care will peak at eight million next summer if current trends continue, regardless of whether NHS strike action continues.
Patients contacted by their hospital will be asked to specify how far they are willing to travel, with the NHS then identifying alternative hospitals with capacity.
NHS England said in some cases the request will be uploaded to the NHS’s Digital Mutual Aid System – its hospital matching platform – to see if NHS or independent sector providers elsewhere in the country can provide their care.
Patients will remain on the waiting list for their home hospital until there is confirmation that their full care pathway has been moved to another provider. If no alternative is found within eight weeks they will retain their position on their current waiting list.
The NHS estimated that approximately 400,000 patients – or 5% of the overall waiting list – meet the criteria and will be contacted by their hospital.
This system is made possible, the NHS said, thanks to ‘the hard work of NHS staff‘ as well as innovations such as ‘surgical hubs, community diagnostic centres, and the use of robots and AI to speed up surgery and other treatments‘.
NHS chief executive Amanda Pritchard said: ‘Despite pressure and the huge disruption caused by strikes, NHS staff have made great progress in reducing the longest waits for patients. This new step to offer NHS patients who have been waiting the longest the opportunity to consider travelling for treatment is just another example of how we are introducing new approaches to reduce how long patients wait, while improving the choice and control they have over their own care.
‘Giving this extra option to these patients also demonstrates the clear benefits of a single national health service, with staff able to share capacity right across the country.
‘So, whether a patient’s care moves to the next town or somewhere further away, it is absolutely right that we make the most of available capacity across the country to continue to reduce the backlogs that have inevitably built up due to the pandemic and provide the best possible service for patients.’
Louise Ansari, chief executive of Healthwatch England, welcomed the news but said: ‘We’re now calling on NHS England and integrated care boards to work together to ensure everyone choosing to travel for faster treatment is given support, including with the costs of transport and accommodation – as described in the Elective Recovery Plan. Otherwise, this option risks deepening health inequalities by only providing solutions to people who can afford to contribute towards the additional costs of travel.‘
A version of this story was originally published by our sister publication Healthcare Leader.
26th October 2023
The quality of patients’ access to urgent and emergency care in England ‘depends too much’ on where they live, the House of Commons Public Accounts Committee (PAC) has said in a scathing new report into urgent and emergency care access.
Entitled ‘Access to urgent and emergency care‘, the report said staff ‘have been let down by a system which has seen performance fall far below the standard the NHS says patients should expect to receive’.
It highlights that NHS’s own target for A&E waits had not been met since 2015, and its target for ambulance handovers had been missed each year since it began reporting against this metric in 2017. Regional variation was found to be particularly prevalent, it said.
Proportions of the most serious A&E patients waiting less than four hours in March 2023 ranged from 53.3% in the Midlands to 62.1% in the South East.
Ambulance services covering large rural areas, like the South West and East of England, are especially challenged, with Category 1 response times in 2021/22 varying from 6 minutes and 51 seconds in London to 10 minutes and 20 seconds in the South West.
The PAC said that evidence suggested the Department of Health and Social Care had ‘not sufficiently held NHS England to account’ for meeting targets and improving urgent and emergency care.
What’s more, differences in the capability of individual trusts, including around management, clinical leadership, and technology, were also highlighted. The PAC said these must be addressed to reduce variations in patients’ access to and experience of services.
Commenting on the report, Dr Adrian Boyle, president of the Royal College of Emergency Medicine, said: ’This is another report that lays out the damning reality of emergency care. Our members and their patients are being let down.’
And he described the Committee’s finding that performance varies from region to region as ‘disheartening but not surprising’.
He added: ’We must be able to better understand what is happening at a local level. At the moment we do not know how well or how poorly individual hospitals are doing because the official data is published by each trust, which may encompass several sites.
’RCEM is campaigning for NHS England to publish transparent performance figures for individual A&Es, so increased resources and support can be provided to the sites that are struggling the most. Improving equality of care and resulting in significant benefit to patients and staff.’
The PAC report also highlighted that not enough is being done to tackle delayed discharges, which has a serious knock-on impact throughout the whole urgent and emergency care system, with beds unable to be released for new patients and thus exacerbating A&E waiting time issues.
The number of patients staying in hospital when they no longer need to stood at an average of 13,623 in Q4 of 2022/23, up from 12,118 in the same period one year before.
To this end, Dr Boyle said: ’We are on the cusp of what looks likely to be another devastating winter. Having adequate capacity for our patients is vital. This will reduce dangerous levels of bed occupancy and improve flow through our hospitals and go some way to easing the pressure on the system.
“We know that since the pledge [to] increase bed numbers by 5,000 was made in January, we have not made nearly enough progress on this fundamental solution. The priority must now be on significantly increasing bed numbers before the cold weather, and the inevitable winter pressures hit.’
The PAC also called into question the ‘assumptions underpinning’ NHS England’s plan to retain 130,000 staff over the next 15 years, as set out in its recent workforce plan, particularly given the staff turnover rate in the health service was 9% in 2022/23.
And despite having ‘more money and staff than ever before’, the NHS has made ‘poor use of it’ to improve urgent access for patients with urgent and emergency services ‘deteriorating’ in spite of greater spend, it concluded.
It also flagged a 23% fall in NHS productivity following the Covid-19 pandemic, even though it had been improving pre-pandemic.
It has now called on NHS England to set out its understanding of the causes for the fall in productivity and how it will address them.
Similarly, it urged NHS England to establish the causes for variation in performance, and how it might bring the ‘worst-performing organisations’ closer in line to the standards achieved by the best.
Committee chair and Labour MP Dame Meg Hillier said: ‘Excluding demand-led spending such as welfare payments, health takes up approximately 40% of day-to-day budgeted spending by Whitehall departments. It is vital this is delivering benefits for patients. The Government and health system need to be alert to the serious doubts our report lays out around the workforce crisis, both the approach to tackling it now and the additional costs funding it in the future.’
Responding to the inquiry report, NHS England’s national clinical director for urgent and emergency care, Professor Julian Redhead, said: ‘While this report includes data which is more than two years old and coincided with a once in a generation pandemic, it is right to note the NHS has been under increasing pressure with staff experiencing record A&E attendances, hospitals fuller than at any point in their history and with thousands of beds taken up each day, in part, due to pressures in social care.
‘It is testament to the hard work of staff and results of our NHS winter plan – rolling out 800 new ambulances, 10,000 virtual ward beds and work towards 5,000 extra core beds – that waiting times for ambulances, 999 calls and in A&E have improved across the country during this financial year.
‘This progress has come as the NHS has committed to delivering £12bn of annualised savings by 2024/25 – all while dealing with more than a 100,000 staff posts being vacant.’
A version of this story was originally published by our sister publication Healthcare Leader.
25th May 2023
Patients will be able to choose from up to five different care providers through the NHS app when they are referred by a GP for treatment, the UK Government has announced.
Giving more options of where patients can go for treatment, including NHS care provided in the independent sector, could cut up to three months off waiting times, the announcement said.
Information for healthcare providers – filtered by distance, waiting times and quality of care – will be available to patients after they have spoken to their GP and they can choose which option they prefer through the NHS app or website.
Currently, figures suggest only one in 10 patients exercise their right to choose, which the Government said it wanted to change by providing more information for patients.
From October, patients already waiting more than 40 weeks for an appointment, and patients that have a decision to treat but have not yet been given a treatment date, will also be asked whether they want to switch hospitals, if possible and clinically appropriate.
In April, the Government commissioned Hewitt review said patients should have greater access to their NHS record, including checking their position on waiting lists and removing themselves.
Prime Minister, Rishi Sunak, said: ‘Empowering patients to choose where they receive treatment will help cut waiting lists, one of my five key priorities.
‘Our aim is to create an NHS built around patients, where everyone has more control over the care they receive, wherever they live or whatever their health needs are.’
Health and social care secretary Steve Barclay said every patient should be able to easily choose where they go to receive treatment.
‘Millions of people downloaded the NHS app during the pandemic. Increasing use of this fantastic resource will enable them to exercise more choice and get access to essential information about the options for their care including journey time, length of wait and quality of service – all at the swipe of a smartphone screen.’
Amanda Pritchard, NHS chief executive, said: ‘Despite significant pressure, the NHS reduced 18-month waits for care by more than 90% by April and, alongside existing tools like elective hubs, surgical robots and “prehab” checks, this is another way that we are continuing to embrace the latest innovations and tech for the benefit of patients.’
Joe Harrison, Chief Executive at Milton Keynes University Hospital NHS Foundation Trust, commented: ‘Staff at NHS trusts across the country have been working flat out to reduce the amount of time patients are waiting for elective treatment, and are making incredible progress.
‘Giving patients even more access to information about their appointments, and being able to choose where they take place through the convenience of the NHS app, will help trusts continue to provide patients with the best possible care, as quickly as possible.’
While, the Liberal Democrats’ health spokesperson Daisy Cooper MP said: ‘Rishi Sunak is failing on his pledges to cut NHS waiting lists, recruit the NHS staff we need, and fix crumbling hospitals.
‘This latest gimmick will do nothing to change the fact that under the Conservatives, far too many patients are waiting far too long for the treatment they need.
‘The Government can’t tackle this health crisis until they address the huge staff shortages that blight our local health and care services.’
The Government wants to see 75% of adults in England using the NHS App by March 2024 as the ‘front door’ to the health service.
A version of this story was originally published by our sister publication Pulse.
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