NHS mandate confirms flagship waiting targets on hold

The updated mandate to NHS England, published last night, includes no objective for the 18 week referral to treatment target, nor the four hour emergency department waiting target, to be met during the year.

On performance for 2018-19, it includes a “deliverable” which says: “With NHS Improvement, meet agreed standards on A&E, ambulances, diagnostics and referral to treatment.”

This is the same as the 2017-18 mandate, which reflected an agreement between government and NHS England early last year that there would be no plan to meet the 18 week RTT standard, on the basis it was not realistic within the funding envelope. The 2016-17 mandate was the last to expect delivery of the RTT standard in-year.

Referring to this decision in November, ahead of the budget, NHS England chief executive Simon Stevens said: “To decide that should now be a permanent decision would be to turn back a decade of progress… It’d mean the government having to publicly legally abolish patients’ national waiting times guarantee.”

Immediately after the budget, NHS England suggested funding was still insufficient to meet key targets, while government said otherwise, but an agreement was reached ahead of the publication of 2018-19 NHS planning guidance last month.

The planning guidance said the additional funding made available to the NHS, in the budget and subsequently by the Department of Health and Social Care, meant more operations would be carried out. It said this would mean the waiting list should be held at the same level in March 2019 as at March 2018, and in some areas it may be reduced.

In March 2017, the total list reached 4 million, up by nearly 1 million over the previous two years. The guidance said the number of patients waiting more than 52 weeks would be halved but there was no mention of the 18 week target that features in the NHS constitution.

The mandate again includes the constitutional RTT target – for at least 92 per cent of patients on the list to be waiting no more than 18 weeks – as an “overall 2020 goal”.

On the four hour target, the mandate pushes back by 12 months objectives set in the 2017-18. The NHS must, it says, “deliver aggregate A&E performance in England above 90 per cent in September 2018, with the majority of trusts meeting 95 per cent in March 2019, and aggregate performance in England at 95 per cent within the course of 2019”.

The government’s letter setting NHS Improvement’s remit for 2018-19, also published yesterday, includes the same performance objectives.

A foreword to the mandate by health and social care secretary Jeremy Hunt says: “Providing timely access to health services is a key part of the promises made when the NHS was first established – and despite more people being seen within agreed timeframes, we are seeing a number of hospitals struggling to meet these core performance standards overall.

“The government, therefore, expects the NHS to deliver the actions set out in the NHS planning guidance for 2018-19 – in full – as key steps towards fully recovering performance against core access standards.”

Much of the rest of this year’s mandate is the same as last year’s.

Indicative budget figures published with the document confirm that in 2019-20 NHS England’s administration budget, which must fund its running costs, is due to be cut by nearly a quarter to £352m.