Access standards must be achievable and fully funded

Author: Louise Prime

Any changes to NHS access standards must be achievable and ensure best care for patients as well as being accompanied by a clear and fully funded implementation plan, NHS Providers has insisted. It has also called for realism about trusts’ capacity to implement new standards while they are facing unprecedented levels of demand.

In June 2018 the then prime minister Theresa May asked the NHS national medical director to review the core set of NHS access standards and to recommend any required updates and improvements to ensure that they: promote safety and outcomes; drive improvements in patients’ experience; are clinically meaningful, accurate and practically achievable; ensure the sickest and most urgent patients are given priority; ensure patients get the right service in the right place; are simple and easy to understand for patients and the public; and not worsen inequalities. The review, led by NHS England and NHS Improvement, is examining proposed changes across urgent and emergency care, elective care, cancer care and mental health – and the latest set of findings is expected later this month.

In its report Setting good standards for NHS patient care, NHS Providers acknowledged there are good grounds for regularly reviewing the use of these standards, with a strong clinical focus, but also argued that any changes to access standards must command broad support from patients, the public, politicians, clinicians and trust leaders. And, given the standards’ central role in NHS day-to-day operation, it insisted that any changes must be accompanied by a clear, costed and fully funded implementation plan with a realistic timetable.

The authors set out the key conditions to ensure the success of any new proposed standards:

  • there is a strong, clear and widely supported clinical case for change
  • the standards are meaningful and easy for patients and the public to understand
  • trust leaders are fully involved in the design and implementation of any changes
  • the planning around the implementation is realistic about what resources and time is needed to make any change, given the current operational challenges
  • it must be clear that the changes are not an attempt to abandon the performance levels expected in the current standards, and there is a fully funded plan to recover performance to those levels.

NHS Providers deputy chief executive Saffron Cordery commented: “We fully support the clinical focus that this review of access standards has been given. To date targets have played a crucial role in reducing delays and contributing to safe high quality care so it’s right to look at whether the targets we have today are still clinically relevant and work in the best interests of patients and service users, treating those most unwell most quickly while ensuring everyone has access to timely care.

“But we have to be realistic about the capacity of trusts to implement new standards at a time when they are facing unprecedented levels of demand and performance at its lowest since the existing standards were first introduced. It’s vital that the public understand why changes are being made now and that the current standards are not being scrapped because they can’t be met.

“Alongside considering the capacity needed for the implementation, there are also a number of major operational factors that have to be taken into consideration and will need funding. These include changes to the workforce, which may include additional staff to collect and report on a wider range of standards, and crucially ensuring all trusts are supported to put the required digital capability and infrastructure in place.

“We very much welcome the inclusion of new mental health standards, which are a step towards ensuring parity of esteem for mental health services and supporting new care models. Trusts have also told us they welcome the ambition to speed up diagnostics and improve care for cancer patients. However, trusts will need investment in staffing and facilities to deliver the ambitions set out in both these new sets of standards.

“Ultimately given the fundamental and multiple functions the current standards play within the NHS – it is vital we build a broad consensus and take the time to collectively get this right.”