Focus should be on waiting list size, as well as long waiters says planning guidance

The much-delayed planning guidance for 2024-25, published today, says the NHS must “[recognise] that we cannot continue to reduce long waiters while the overall waiting list grows [and] systems are asked to also focus on reducing the overall list size and improve productivity”.

Nevertheless, the main operational target for the year starting in April remains focused on long waiters.

HSJ’s Recovery Watch  column revealed yesterday  that NHSE leaders are preparing to draw up a new version of the elective recovery plan with system leaders wanting to pivot away from the focus on blunt targets for reducing the longest waiters towards a more holistic approach based on reducing the entire list. 

Prime minister Rishi Sunak set reducing the overall NHS waiting list by 2024 as one of his “big five” ambitions in January 2023, a target which was missed.

But NHSE has always remained more committed to prioritising the elimination of the longest waiters, as per the ambitions set out in its elective recovery plan  published in February 2022, which had an ultimate end goal of eliminating all 52-week breaches by March 2025.

The 2022 plan said if it increased capacity as hoped, “then we would expect the waiting list will be reducing by around March 2024”, but it was not a target in its own right.

The guidance confirmed the target to eliminate 65-week waiters was being pushed back from March until September, as revealed by HSJ in February.

It also confirmed the elective activity target for 2024-25 will be the same as it was for this year, to deliver at least 107 per cent of pre-covid “weighted activity”, also previously reported.

The document provided some fresh detail on NHSE’s new outpatients target. As reported last month, the system’s existing outpatient target, to cut follow ups by 25 per cent, is being replaced by a target based on the ratio of all outpatient attendances compared to those which are “pathway completing”.

According to today’s guidance, the new national target is specifically to “increase the proportion of all outpatient attendances… attracting a procedure tariff [ie complete a patient’s pathway] to 46 per cent across 2024-25”.

Other key performance asks

The guidance sets out 32 main targets in total, many of which are similar to those set in 2023-24 or effectively delay recovery targets which have been missed.

On cancer, it asks systems to achieve 77 per cent on the new faster diagnosis target in 2024-25, which says patients should be given their diagnosis within a month of an urgent referral. This is halfway to achieving 80 per cent by 2025-26.

Performance last year and this year to date were 70 per cent and 72 per cent respectively.

The target of hitting 70 per cent against the 62-day treatment target by March 2024 has been pushed back to March 2025.

The guidance said: “The intention [is] to shift focus away from the 62-day backlog and towards 62-day performance based on reducing the backlog to manageable levels. Systems need to retain the progress made.”

Average performance on the target last year and this year to date was 65 per cent and 64 per cent respectively.

On urgent and emergency care, the guidance sets a target to achieve a minimum of 78 per cent against the four-hour target by March 2025 — 2 points higher than the 2023-24 target, as HSJ reported earlier on Wednesday. It repeated the target to improve category 2 ambulance response times to an average of 30 minutes.

On mental health, the guidance reiterated the need to focus on “recovering performance” for children and young people’s eating disorder services. But it said there would be an additional £70m of service development funding, which is understood to be new money.

The guidance also pledged to increase the number of adults and older adults completing a course of treatment for anxiety and depression via NHS Talking Therapies to 700,000, with at least 67 per cent achieving “reliable improvement and 48 per cent reliable recovery”.

This represents a more specific talking therapies target than last year’s broad pledge to ensure an “increase [in] the number of adults and older adults accessing IAPT treatment”

This year’s guidance also pledged to increase the number of people accessing transformed models of adult community mental health to 400,000 – up from a previous target of 370,000 last year.