• Plan pledges faster access for sickest but sets no timetable for hitting core standards
  • Clinical standards review to report in spring but providers raise concerns
  • Plan sets out new targets for outpatients and “same day emergency care” 

The NHS long-term plan has set no commitment on when the service will get back to meeting its core statutory access targets.

The long-awaited plan, published today, did pledge to speed up access for the sickest patients. But it made no commitment to meet flagship statutory targets, like the four hour benchmark in accident and emergency, ahead of the conclusion of the clinical standards review due in the spring.

Both NHS England chief executive Simon Stevens and prime minister Theresa May also declined to give definitive answers when asked if the health service would get back to meeting its core targets during media interviews ahead of the launch of the plan today, prompting concerns from providers.

The omission of specific pledges on core targets follows NHS Improvement warning in November that it could take up to five years to get the service back on track on its core performance standards.

The NHS long-term plan said: “[The clinical standards review will] develop new ways to look after patients with the most serious illness and injury, ensuring that they receive the best possible care in the shortest possible timeframe.

“For people who arrive in A&E following a stroke, heart attack, major trauma, severe asthma attack or with sepsis, we will further improve patient pathways to ensure timely assessment and treatment that reduces the risk of death and disability.”

The plan commits to “cut long waits and reduce the waiting list” for elective procedures, but not to get back to 92 per cent of patients being seen within 18 weeks. It also noted “waiting times remain low by historic standards”.

The document set out plans for new targets in a range of areas. They include:

  • Emergency care: The service willtest and begin implementing” new emergency and urgent care targets from October, as suggested in the 2019-20 planning guidance published last month.
  • Emergency care: Hospitals must meet new “same day emergency care” standards, as reported by HSJ earlier today. The plan sets a target to increase the proportion of acute admissions discharged on the day of attendance from a fifth to a third.
  • Electives: Patients waiting over six months will be “reviewed and given the option of faster treatment at an alternative provider, with money following the patient to fund their care”.
  • Outpatients: The NHS will cut “a third of face-to-face outpatient visits” over the next five years. This will cut up to 30m outpatient visits a year and save £1.1bn in “new expenditure averted”, it said.
  • Ensuring patients are in the right place: A new single multidisciplinary “clinical assessment service” will be set up to help patients “navigate the optimal service channel” and get them to the most appropriate service. “By 2023, [the new clinical assessment service] will typically act as the single point of access for patients, carers and health professionals for integrated urgent care and discharge from hospital care,” the plan said.

Mr Stevens said during an interview on the BBC Today programme that the lack of targets at this stage should not be interpreted as a signal that NHS bosses planned to change the targets which were being missed.

He said: “The top doctors in the NHS are looking at what are the most appropriate standards to improve outcomes in emergency care [in the clinical standards review]. Then they will make their recommendations, then we will meet them.”

He also said the NHS needed “a tougher, faster set of standards for some major conditions like…sepsis, heart attack and stroke” because the four hour target “does not distinguish between turning up to A&E with a strained finger and turning up with a heart attack”.

The comments follow HSJ reporting last month that the clinical review group had debated ditching the four hour target for minor ailments – a move which prompted concerns from senior emergency medics.

NHS Providers said recovering performance against the key NHS constitutional standards was a “major issue” that had not been addressed by the plan.

Chief executive Chris Hopson told HSJ providers would want to know “how quickly, over what time period and how [meeting the existing core standards] will be funded”.

“Trusts are ready to consider modernising the standards – clinical practice has changed beyond recognition since they were introduced. But trusts will also not want to see the hard won gains of the 2000s in reducing waiting lists and improving care lost.”

Mr Hopson also cautioned that previous target regime changes had been carried out over a period of years rather than months, as is suggested in the plan which said the clinical standards review group would report in the spring and the rollout of some new targets would begin in October.

“As we know from the review of ambulance targets, we need to build the right evidence based consensus and then operationalise those new standards. That takes time,” he said.

UPDATED: This piece was updated at 15:22 on 7 January to include comments from NHS Providers.