NHS England’s board met last week, with discussion including key statistics for areas of focus within the NHS; plans for data improvements in specific areas; and comments around how the NHS can support the government’s planned shift towards preventative, digital and community-based care.
Some of the key stats include how 76.3 percent of patients attending A&E were admitted, transferred or discharged within four hours; below the NHS constitutional standard of 95 percent, but a slight increase from 75.2 percent in July this year. 8.6 percent of patients were reported to spend 12 hours from arrival in A&E in August’s provisional figures, down from 9.1 percent the month before. NHSE notes a reduction in the longest waits for care, with 2,738 patients waiting more than 78 weeks for treatment at the end of July 2024, in comparison to 7,079 at the end of July 2023. Additionally, by the end of July there were 1.63 million patients on the diagnostic waiting list, with 364,544 of those waiting six weeks or more; the percentage of six-week waits in itself has reduced to 22.4 percent, from 25.4 percent the year before.
On waiting lists, NHSE highlights how the services with the “largest percentage of the total waiting list waiting over 52 weeks in July 2024” was that of children and young people (CYP) community paediatric services, with 26 percent waiting over 52 weeks. In order to address challenges in this space, work is underway on data definitions of service lines to help prepare for a potential national standard. NHSE is also looking to undertake a “deep dive” for community paediatrics and CYP community therapies, in order to establish a baseline position and understanding of these services. This will include quantitive data on what is driving demand; workforce models; service pathways; and capacity issues.
Regarding primary care and community health services, NHSE highlights how July saw the launch of the Health Insight Survey which will aim to provide insight into patient experience on GP access, dentistry, community pharmacy and the elective waiting list. At present, NHSE is developing its approach on how these insights will be shared with regional teams in order to support improvement activities. The survey is set to run every four weeks, with the next publication due on 10 October.
The board heard some results from the September survey; 47.1 percent of respondents had tried to contact their GP practice in the last 28 days, and 76.8 percent said that they had been able to make contact on the same day. Of these, 60.9 percent said they found it easy to contact their GP practice, and 67.4 percent indicated they had a good overall experience with their practice.
Looking at community mental health services, NHSE states that there is an expected focus on data quality improvement in 2024/25 to enable more accurate data from April 2025 onwards. NHSE is also supporting data improvements for the urgent and emergency mental health pathway, along with improving quality and completeness of data submissions for the CYP eating disorder pathway.
Coming back to community metal health in particular, NHSE highlights a programme of work to improve these services which has taken into account data such as national surveys and complaints as well as consultations, engagement and partnership working with voluntary, community and social enterprise groups. Setting out the existing situation, NHS states: “Despite the increase in access and steps to transform services, a significant treatment gap remains.” Referrals are reported to have increased faster than supply, which has impacted on waiting times, with the 90th percentile wait currently at 114 weeks.
Acknowledging figures around “notable serious untoward incidents” and suicide deaths by mental health patients, NHSE sets out a number of actions designed to improve quality and safety in community mental health services. These include a longer-term review into the whole system approach, which will explore the data, capital and resources required to meet demand as well as the changes required to ensure efficient flow and high quality patient care within and between services. This review is to launch at the beginning of 2025 and aim to report by the end of 2026. In the shorter term, NHSE adds, the national team is developing wider guidance on what good quality, safe care looks like in this space with external partners including the Royal College of Psychiatry and CQC, which will be published by the end of the financial year.
On financial performance, the board explored the NHS’s position at month four of the financial year; they heard that the month four expenditure limit (£179.1 billion) includes a number of additional funding streams recognised by the Department of Health and Social Care, but not yet included in the published financial directions, including additional funding for technology investment.
Regarding integrated health and care, the board acknowledged the government’s commitment to three strategic shifts for the NHS, including the move from analogue to digital alongside shifting from treatment to prevention, and from hospital to primary care and community services. “The recent report by Lord Darzi has also supported this strategic direction,” the report states, “highlighting that a more joined-up approach and transformation shift is required to resolve the current fragmented model.”
In light of this, NHSE raises key questions, including: what needs to happen nationally and locally to support these strategic shifts? The board was also presented with a transformation case study from NHS Lancashire and South Cumbria ICB, with NHSE asking for considerations around the learnings that can be taken from the ICB’s approach.
NHSE’s latest board papers can be found in full here.
Also from NHS England
At the start of October HTN highlighted improvement guides and analytic tools published by NHSE, designed to help support flow through the emergency care pathway; to generate greater value for patients from theatres, elective surgery, perioperative care and outpatient services; and to improve medical consultant job planning.
We explored a newly released strategy detailing the primary care implementation of the NHS patient safety strategy, noting the role of digital and data in areas such as automatically flagging patient safety issues to support reliability, and supporting clinical decision-making by digitally embedding diagnosis advice and safety netting.
Priorities for the winter period and steps to be taken by NHSE, ICB and providers were shared here; and we looked into NHSE’s virtual wards operational framework here.
And HTN reported on NHSE’s last board meeting in July here.
