• Ministers and NHS should “think more broadly about NHS targets”
  • Comes amid row over whether NHS can be required to meet core targets in 2018-19
  • NHS England should monitor impact of relaxing targets on experience and care in general
  • Healthwatch England submission also raises concerns about involvement in STPs, hospital discharge and mental health

Obsession with waiting time targets is preventing a proper debate about public and patient priorities, ministers have been told as they work on setting NHS England’s mandate for 2018-19.

However, Healthwatch England’s official submission to the mandate setting process, shared with HSJ, also warns that if targets are further relaxed – as NHS England has said may be necessary – then the real impact on patients must be monitored better.

The government publishes a mandate document for each financial year, setting out objectives and requirements for NHS England. It has become one focus of a row about what the NHS can achieve within current funding. After the budget, ministers indicated the service would be expected to meet its targets, but NHS England has said “the NHS will likely not be able to do everything being expected of it” with the budget available. There is also speculation that the current objective to meet the four hour emergency department target by the end of 2018 may be further deferred.

Along with NHS England, Healthwatch has to be consulted on the mandate every year. Its submission identifies six key areas it wants ministers to consider, one of which is “targets and the experience of users”.

The submission says people are increasingly “struggling to get the care they need”. It says many accept the NHS needs to prioritise and adds: “A broader conversation around NHS prioritisation is currently being prevented from taking place because the focus of existing NHS targets and monitoring systems doesn’t allow for adequate consideration of the experience of patients. Indeed, what is currently measured in the NHS is not always what matters most to people.”

However it also says: “If the department intends to… re-set expectations around any particular NHS target, then it should require NHS England to monitor and publish the impact of this decision. For example, if the 18 week RTT is relaxed then NHS England should be required to track any potential changes to operation cancellations or changes in satisfaction levels.

“More broadly the department should look to use the mandate to instruct NHS England to think more broadly about NHS targets and capturing more contextual information to help create a more balanced conversation about how people’s care needs are met with the resources [made] available by parliament.”

Healthwatch’s other asks include: sustainability and transformation partnerships’ ratings to include how well they involve the public; steps to ensure Mental Health Forward View initiatives are working; better monitoring of patients’ experience of and after hospital discharge; and “hardwiring complaints and feedback data” into how services work.

The mandate is expected to be subject to further discussion in coming weeks. The Department of Health and Social Care has to publish it by the end of March. There is also discussion this year about it being more closely linked to the department’s remit for NHS Improvement, to try to prevent disagreements between the three.

NHS England and NHS Improvement are expected to publish updated planning guidance for 2018-19, which will signal priorities and requirements, in the next few weeks.

The DHSC said it would consider Healthwatch England’s submission.