Summary of board meeting: NHS England - October 2024

For more detail on any of the items outlined in this summary, please find the full agenda and papers.

• Work to support the government’s new priorities is ongoing.
• NHS England (NHSE) recognises, accepts and endorses the findings of the Darzi review, including its optimism around building an NHS fit for the future.
• NHSE will continue to focus on elective care over the winter period. There are particular considerations for patient care, quality and safety.  

Urgent and emergency care

• Demand for urgent and emergency care (UEC) services fell in August 2024. The average daily attendances for UEC decreased to 69,703; this is 6.9% lower than the July daily average, but  2.4% higher than the same point last year. 
• In August, 76.3% of patients attending A&E were admitted, transferred or discharged within four hours. While this is an increase from 75.2% in July 2024 and 73% in August 2023, it is still below the constitutional target of 95%.
• Ambulance services answered 754,495 calls to 999 in August 2024; a decrease of 2% compared to August 2023. 
• The average ambulance response time for Category 2 calls was 27 minutes and 25 seconds. While this exceeds the 30 minute target for the year, it remains above the NHS constitutional standard of 18 minutes. Since August 2024, NHSE has been publishing average Category 2 call response times each month through integrated care boards (ICBs). 
• NHS 111 received 1.6m calls in July 2024. Demand was down 1.4% compared to the same month last year. The proportion of calls abandoned dropped 0.4% from the previous month, with the average speed to answer also falling by five seconds.

Elective recovery

• There were 7.62 million waits for procedures and appointments and an estimated 6.39 million people waiting for care at the end of July 2024. 
• 290,326 patients had been waiting for treatment more than 52 weeks by the end of July, compared to 388,505 in July 2023. The number of patients waiting more than 65 weeks for treatment was 50,860 at the end of July, compared to 96,023 at the same point in 2023. 
• There has also been a reduction in the longest waits for care; 2,738 patients were waiting more than 78 weeks for treatment at the end of July. This is compared to 7,079 at the end of July 2023 (a significant reduction of 61.3%). 
• At the end of July, 107 patients were waiting more than 104 weeks for treatment (compared to 263 patients at the same point in 2023).   
• There were 1.63 million people on the diagnostic waiting list in July, with 364,544 of these people waiting six weeks or more.

Cancer

• Levels of urgent suspected cancer referrals have remained high, with 12,270 patients seen per working day in July 2024. This is 27% more referrals than before the pandemic – equivalent to 3,000 more patients per working day. 
• Treatment activity was also at a record high level, with over 1,400 patients starting cancer treatment per working day. This is 15% above pre-pandemic levels.
• The increase in referrals has also contributed to increases in earlier cancer diagnosis. This is approximately 2% higher than before the pandemic. 
• There has been an acceleration in the installation of new diagnostic capacity, much of it in community diagnostic centres. 
• Performance against the Faster Diagnosis Standard in July was 76.2%. This is the fifth time in six months that the 75% standard was met. NHSE has announced that this standard target will increase to 80% by March 2026.
• In July, performance against the 62 day Urgent Referral to First Treatment Standard, was 67.7%. This is 2.1% higher than at the same point last year, but still below expectations. NHSE has set the ambition to improve this to 70% to March 2025, as a first step in recovering performance to the 85% standard.

Mental health

• The mental health service data shows that 59,632 people accessed a specialist community perinatal mental health (PMH) service, or a maternal mental health service (MMHS), in the 12 months to July 2024. This represents a steady growth in access since March 2021.
• However, access to these services remains more than a year behind trajectory to meet the target set out in the NHS Long term plan (LTP) for 66,000 women with moderate to severe perinatal mental health difficulties to access specialist care by 2023/24. 
• NHSE plans to publish full community mental health (CMH) metrics in autumn 2024. This will begin to show the percentage of people receiving meaningful help within four weeks of referral to adult CMH and children and young people services. There will likely be a focus on improving data quality in 2024/25 to support more accurate data from April 2025. 

Recovery support programme

• The recovery support programme (RSP) provides national mandated intensive support to trusts and ICBs in NHS oversight framework segment 4. The RSP now has 21 trusts (four legacy special measures), with three ICBs enrolled.

For an exhaustive breakdown of operational performance, please click on the link provided.  

Month 4 financial position

• As a result of a lower level of revenue growth in 2024/25, NHSE is providing an additional £2.3bn of funding to support systems to breakeven. 
• NHSE will also allocate funding to cover the cost of pay deals and the direct costs of industrial action. 
• The requirement on systems and providers is to deliver financial plans approved by their boards for the year.
• Compared to projections, the aggregate system position shows expenditure to be above plan, at £487m (1% variance versus allocation). This is with a net year to date overspend of £387m at the aggregate NHSE level.
• The overall adverse variance reported at month 4 is driven by overspends by providers. Much of this is due to slippage against efficiency plans and the impact of industrial action over summer.

Capital allocation

• Providers have spent £1130m on capital schemes to month 4. This excludes International Financial Reporting Standard 16 expenditure relating to lease assets.
• Capital spending represents 15% of full year budgets (compared to 14% at the same stage last year). For a full breakdown of financial performance, please click on the link provided here.  

• The government has a commitment to three strategic shifts for the NHS, which are moving from:
• hospital to primary care and community services, 
• analogue to digital, and 
• treatment to prevention.
• There are also government plans to develop a neighbourhood health service, with more care delivered in local communities, supported by a shift in resources. The findings from the Darzi report support this approach.  

• Access to adult CMH teams has increased by 29% since March 2020, following £1bn of investment in the NHS LTP to support more personalised care in the community. 
• The government’s commitment to modernise the Mental Health Act will improve how patients are engaged in services. 
• NHSE wants to learn from international models which are located in neighbourhoods and bring together community care, crisis care and inpatient care into one team. There is a recognition of the vital role continuity of care plays in providing safe care.
• NHSE is currently working with six health systems across the country to implement 24/7, open access mental health centres, which will bring together community teams, crisis services, and crisis beds. People will be able to access mental health care without booking an appointment. 
• This integrated one team approach builds on the evidence of effective engagement with people with serious mental illness.