Clinical review of NHS access standards

It is well documented that standards and performance targets have incentivised and encouraged improvements in care and outcomes, and provided assurance on quality and availability of care when people need it. It is also recognised that in some cases the same targets can restrict the ability to innovate or result in other unintended consequences.

The NHS Long Term Plan sets out an ambitious but practical roadmap for the future of the health service that builds on the undoubted success of the last 70 years and ensures it will continue to deliver high quality care for all over the coming decade. The Government has now confirmed the long-term funding settlement – providing the NHS with the sustainable financial basis on which to deliver the Plan.

The history of the National Health Service is one of evolution and innovation, with each generation using the latest technology and treatments to meet the changing needs of patients and the public.

NHS access standards review

With all of this in mind, the NHS National Medical Director was asked by the Prime Minister in June 2018, to review the core set of NHS access standards, in the context of the model of service described in the NHS Long Term Plan, and informed by the latest clinical and operational evidence, recommend any required updates and improvements to ensure that NHS standards:

  • promote safety and outcomes;
  • drive improvements in patients experience;
  • are clinically meaningful, accurate and practically achievable;
  • ensure the sickest and most urgent patients are given priority;
  • ensure patients get the right service in the right place;
  • are simple and easy to understand for patients and the public; and
  • not worsen inequalities.

The review is being undertaken in three phases:

  1. Consider what is already known about how current targets operate and influence behaviour
  2. Map the current standards against the NHS Long Term Plan to examine how performance measures can help transform the health service and deliver better care and treatment
  3. Test and evaluate proposals to ensure that they deliver the expected change in behaviour and experience for patients prior to making final recommendations for wider implementation

To support this work a Clinical Oversight Group was established, which includes members from the Academy of Medical Royal Colleges, the Royal College of Surgeons, the Royal College of Physicians, the Royal College of Nursing, Healthwatch, and senior members of NHS England and NHS Improvement clinical teams. The group met regularly during the initial two phases of the Review and will continue to meet and input during phase three.

Interim report

The interim report published in March 2019 sets out the initial proposals for testing changes to access standards in mental health services, cancer care, elective care and urgent and emergency care. These proposals will now be field tested at a selection of sites across England, before wider implementation. The approach and timeframe for this testing varies across the four service areas according to the nature of care and the changes that are being proposed.

During the testing phase and alongside evaluation, we will continue to engage with partners and key stakeholders nationally, and through our test sites to gain expert advice and input locally.

The information we gather through field testing, and engagement will inform final recommendations from this Review, and ahead of full implementation beginning spring 2020.

The following hospital trusts have worked with the NHS nationally to agree how they will safely test the urgent and emergency care proposals, and began the trial from May 22nd:

  • Cambridge University Hospitals
  • Chelsea and Westminster Hospital
  • Frimley Health
  • Imperial College Healthcare
  • Kettering General Hospital
  • Luton and Dunstable University Hospital
  • Mid Yorkshire Hospitals
  • North Tees and Hartlepool
  • Nottingham University Hospitals
  • Plymouth Hospitals
  • Poole Hospital
  • Portsmouth Hospitals
  • Rotherham
  • West Suffolk.

The organisations participating in the other clinical areas will be published here when they are confirmed.

Read the Clinical Review of NHS Access Standards Interim Report from the NHS National Medical Director, Professor Stephen Powis.

Find out more

If you have any further queries regarding the review, please contact