Over the past two decades the constitutional access standards have come to act as an important organising principle for the NHS. Measuring how long people wait to access particular NHS services is now a fundamental element of assessing quality of care, patient experience, and benchmarking how the NHS is performing overall.
The access standards fulfill a number of different roles within the health system, and must speak to a range of audiences. They must be useable, for patients, clinicians, service managers and trust boards. They are central to national oversight by regulators, and enable tax payers and the media to hold politicians and the service to account for its performance.
Measuring how long people wait to access particular NHS services is now a fundamental element of assessing quality of care, patient experience, and benchmarking how the NHS is performing overall.
Any change will come with consequences. One simple way to ensure that the levels of performance currently set out in the NHS constitution are not abandoned is for the NHS to continue to publish data against the old standards during the transition period. This is important as the new proposals would see the NHS in England step away from comparative measures used across the devolved nations within the UK, losing the time series data currently used to track performance over time and benchmark with other countries.
The debate on changing the standards to date has focused on the higher profile A&E four-hour and elective surgery 18-week standards. While there are consistent challenges in changing any standard, the reality is that each proposal needs to be examined on its own merits. The debate to date has focused largely on the benefits and risks of amending the four-hour A&E standard and measures around elective care. However, there is wide support for the proposals to develop new standards across a broader range of mental health services - an important step towards parity of esteem in providing more information about the demand for, and access to, mental health services and a potential means to measure new models of care. Trusts are also positive about the ambitions set out in the proposed new cancer standards which would result in people receiving a diagnosis and starting treatment more quickly. If the NHS is resourced to meet these new standards, they will prompt a genuine improvement for patients.
There is wide support for the proposals to develop new standards across a broader range of mental health services - an important step towards parity of esteem in providing more information about the demand for, and access to, mental health services and a potential means to measure new models of care.
All targets and standards drive different behaviours, and come with different pros and cons. However, it is certainly the case that any proposed changes to the current access standards will have extensive ramifications for trusts and how they operate. Variability in digital maturity, barriers to sharing data locally, workforce shortages and limited capacity across services already threaten the success of implementation without these things being considered in advance.
In our briefing published today, we conclude that trust leaders will support any change to the standards, as they have done previous amendments to ambulance standards and the introduction of mental health standards, if five key conditions are met:
- There is a strong, clear and widely supported clinical case for change.
- The standards are meaningful and easy for patients and the public to understand.
- Trust leaders are fully involved in the design and implementation of any changes.
- The planning around the implementation is realistic about what resources and time is needed to make any change, given the current operational challenges.
- The changes are clearly not an attempt to abandon the performance levels expected in the current standards, and there is a fully funded plan to recover performance to those levels.
Changing the access standards in the NHS constitution handbook needs to be considered from the full range of perspectives, underpinned by extensive engagement and consultation, in order to command the support of patients, the public, politicians, clinicians and trust leaders. All those who have a stake in the standards need to be part of the debate. Given the important functions the current standards play – it is vital we build a broad consensus and collectively get this right.