• Long-term plan will signal performance “reset” over the next five years, says NHSI
  • Warning is NHS’ most explicit attempt to date to urge realism over new plan
  • Follows years of missing core targets despite repeated pledges they would be met

It could take up to five years to get NHS performance back on track, NHS Improvement said today.

In a major intervention in the development of the service’s new long term plan, expected this year, NHSI said it could take until 2023 for performance targets to be hit.

An NHSI statement published today said: “The long-term plan for the NHS will signal a reset on performance over the next five years, as frontline staff and managers continue to ensure record numbers of patients get the healthcare and support they need.”

HSJ understands the statement represents a desire by system leaders to stress the need for a realistic approach to what can be delivered by the new £20.5bn funding settlement given the immense stress already on the system.

It comes as NHSI’s data for the second quarter of 2018-19 confirmed the system was continuing to struggle against both its financial and performance targets with the provider sector recording a £1.23bn in deficit at the end of September

The statement stressed the rising pressure already on the system. It added: “This comes as the latest figures on the NHS’ performance, covering July to September 2018, show that hospitals admitted nearly 1,000 more emergency patients a day and their [accident and emergency departments] treated nearly 2,000 more patients a day within the four hour target compared to the same period last year.”

Publication of the NHS long-term plan has faced delays, but senior figures told HSJ they still expect it before Christmas.

If the plan does set long-term trajectories for getting performance back on target, it would break a cycle in recent years in which system leaders have pledged to get back on track within a year, only to fall significantly short and be forced to kick the objective into the next year.

It follows a sustained lobbying exercise by NHS Providers which has urged system leaders not to make too many new commitments given that all the new money could easily be allocated in addressing existing problems.

Breaking the cycle of over ambitious targets?

System leaders appear to be laying the ground to set longer term objectives for getting performance on track after years of promising to deliver ambitious targets in year, only to fall short – a cycle which has cost them credibility with government.

The NHS last hit the 95 per cent target in July 2015 but system leaders have promised to get this back on track for the last two years. Next Steps to the NHS Five Year Forward View, published in March 2017, pledged most trusts to be fully compliant at 95 per cent by March 2018, and the whole system by the end of 2018. This has failed.

The 2018-19 planning guidance, published in February 2018, said it would “roll forward” with an overall aim of getting the system back on track “within the course of 2019”. It is widely accepted that this is unlikely.

Likewise with the headline elective target. The 2018-19 planning guidance pledged to keep the waiting list in March 2019 at the same level as it was in March 2018, which was 3.84 million.

There were 4.3 million people on the waiting list as of September and system leaders have privately abandoned hope of hitting it.

It is also three years next month since the system hit the headline target for 85 per cent of patients to receive their first definitive treatment within 62 days of an urgent GP referral.

NHSI chief executive Ian Dalton said: “The NHS is working flat out to ensure record numbers of patients get the care they need. Frontline staff and managers deserve tremendous praise for their heroism.

“But this achievement continues to come at a cost with performance targets not being met nationally and hospitals being unable to balance their books to cover the increased demand on their services.

“The long-term plan is our opportunity to fundamentally redesign how the NHS works so that it can continue to provide high quality care for patients.”

NHS Providers chief Chris Hopson said: “We have to be honest about the demand and workforce pressures in front of us and what it will take to meet these challenges. And we have to stop setting trusts overambitious performance and financial targets that they cannot meet, despite best efforts.

“However much we want to focus on new commitments and NHS transformation, we have to get back to delivering the right quality of care within the allocated funding. That means devoting the right amount of recent NHS funding increases to recovering constitutional performance standards and eliminating ongoing provider financial deficits.”

NHSI: Restoring performance may take until 2023