Foreword: A view from Richard Meddings, Chair

As the NHS continues to recover from the impact of the COVID-19 pandemic and focuses on making the improvements we all want to see, it is also contending with complex challenges.

We recognise that we are not meeting a number of our constitutional performance standards but we remain very focused on year-on-year operational performance improvement.

We welcome the recently published independent review of the NHS, led by Lord Ara Darzi. He and his team have done a diligent job in providing a full and accurate picture of the health service now and the drivers of the challenges it faces, and we look forward to working with the Government on the 10-year health plan to address them and to set a realistic but also ambitious blueprint for the future.

In building an NHS fit for the future, we will need to tackle head on the challenges identified in this report.

The NHS faces exponential growth in demand from a growing and ageing population, from societal challenges including cost of living pressures and deprivation, the continued surging levels of demand growth in mental health and from significant increases in obesity. Additionally, our brilliant medical scientists find ever new ways that the human condition can go wrong and ever new methods of treatment. This high growth in demand is met by a capacity constrained system, with workforce vacancies, far fewer hospital beds and much less diagnostic capacity than the Organisation for Economic Co-operation and Development average and an estate requiring high levels of investment in urgent remediation and in modernisation. These longer-term challenges were made more difficult in the year by industrial action which resulted in a notable loss in capacity, with around 1.3 million elective attendances and inpatient and outpatient appointments necessarily postponed or cancelled and rescheduled.

And yet despite these challenges the NHS this year still provided absolute record levels of healthcare.

In general practice we made millions more appointments available for patients with 371 million appointments in the 12 months to the end of March 2024 – circa 7% higher than 2022/23 and almost 21% more than pre pandemic. There are more than 7 million appointments in primary care every week. This is equivalent to more than 10% of the population being seen each week in primary care.

Significant progress was made in urgent and emergency care (UEC) and our urgent community response (UCR) teams continued to provide urgent care to people in their homes, avoiding unnecessary hospital admission.

Despite the ongoing impact of industrial action we have treated more elective patients during 2023/24; 17.4 million elective pathways were completed – an increase of 1.3 million compared to 2022/23. The number of longest waits has also been reduced, with a 52% reduction in patients waiting 65 weeks or longer as well as further reductions in those waiting 78 weeks or longer.  But we have much more to do.

We’ve also had our highest ever performance against the Faster Diagnosis Standard and another record-breaking year for urgent cancer checks with over 3 million referrals between April 2023 and March 2024, more than double the 1.4 million cancer referrals and checks performed 10 years before.

We’ve seen record numbers of people supported by mental health services. In 2023/24 around 5 million people were in contact with NHS services for support with their mental health, over 1 million more than in 2018/19, only 5 years before.

Technology is also helping us to provide more proactive, personalised care for patients with long term needs. We now have an NHS App used by 34 million subscribers, over 75% of the adult population. Just in the month of April, people viewed or changed 7.7 million secondary care appointments through the App, ordered 3.9 million repeat prescriptions and accessed 1.6 million online consultations. The App can be revolutionary to the experience of patients and enables much greater productivity, particularly in primary care. We have in the year purposefully invested at pace in scaling up its use and functionality.

Whilst our basic services have at times been under very real pressure, and particularly in the winter months, what is also clear is the continued innovation across the NHS. World leading genomics, liquid biopsies, a cancer vaccine launchpad with individually tailored vaccinations promising a new weapon with which to fight cancer, greater interoperability of data as we connect secondary systems through the Federated Data Platform, electronic patient records in nearly every trust and in primary care; these will, over time, transform the system.

We also face new and growing risks in this digital age from cyber-attacks and indeed this year we have seen an increased level of attack. Future proofing ourselves against these risks needs to be a priority as we take stock and look to innovate further.

We all know that the NHS needs well-trained, well-supported managers at every level to make the changes needed to deliver an NHS fit for the future. This is why we are taking forward the excellent work of Messenger and Kark to develop a new, multi-disciplinary NHS Management and Leadership Framework.

So, we have the building blocks of a vision to reimagine the NHS for the needs of tomorrow.

So, despite the serious challenges we need to overcome, as Lord Darzi says the vital signs are strong, and so I believe we can be positive for the future.

I would like to thank our staff across the NHS who are today providing record levels of healthcare to meet the changing demands from society and in spite of the many challenges.

Whenever I go on visits across the health system, I am always humbled by the sheer commitment shown each and every day by the people working in the NHS. 

Richard Meddings, Chair of NHS England.