• NHS access standards – measuring patient waiting times in a defined number of areas of NHS service delivery – were first introduced in 1999. As the successful amendment of the ambulance standards, and the introduction of new mental health standards, has shown, it is right to review these standards on a regular basis to ensure they reflect current clinical practice, meet the public’s expectations of access to services and support patient safety.

  • The current access standards have become central to the operation of much frontline service delivery. The standards fulfil a wide range of different purposes – clinically, operationally and in terms of planning, performance measurement, regulation and oversight, governance and accountability. This means that they are used in different ways by different groups of people. For example, members of the public are likely to want to use the standards to understand what quality of care they are entitled to if they need to use a local ambulance, mental health trust or hospital service. However, they are also likely to be interested in the overall performance of the NHS nationally against its key performance standards, given the centrality of the NHS in our national life and the fact that taxpayers fund it.

  • The NHS' principal purpose is to provide outstanding patient care, so it is right that any review of standards should initially be clinically led. But before any standards are changed, it is vital that the needs of the different audiences who use the standards – clinicians, trust leaders, operational managers, politicians, regulators and the national bodies, and the public – should be fully considered. This may require difficult trade-offs – for example, frontline clinicians might prefer a basket of standards reflecting the complexity of care provided in a particular area, whereas those overseeing NHS performance might prefer a single, simple measure which allows easy comparison with historic and international benchmarks.

  • The central role that the current standards now play in how the NHS operates, plans, oversees performance, and is governed and held to account means that the implementation of any changes to the current standards needs to be carefully thought through and fully planned. Changing the standards is a significant undertaking, particularly given the current operational pressure the NHS is experiencing. It is vital that all those involved in the use of standards are properly consulted on what will be needed, including the resource and time required, to ensure the success of any change. Obvious examples of potential challenges in implementation include:
    • The operational change requirements – the IT system, workforce planning, process flow, and changes in performance measurement – needed to adopt new standards in 132 different type 1 accident and emergency departments, for example. In assessing these requirements, it will be important to appropriately recognise variation across trusts, for example in their IT infrastructure.
    • The changes required for trust boards and for the national bodies and regulators, to adapt many of the measures they currently use to manage performance and regulation and oversight respectively.
    • How NHS leaders responsible for performance at a national level can monitor NHS performance and be held to account for it, if the standards change in such a way that a comparison can no longer easily be made with historical data. How the robustness of national system performance data can be maintained over the period of transition if trusts move to implement new measures.
    • How any changes to individual institutional level standards relate to the emerging new sustainability and transformation partnership (STP) or integrated care system (ICS), system-level performance measurement approach currently being developed.

  • Current NHS performance against the standards is the lowest it has been since the standards were first introduced. This is likely to engender suspicion that any attempt to change the standards is being made because recovery of performance to the required standard is either impossible or very difficult to achieve, or will be too costly. It is therefore particularly important that any change should command widespread support across the NHS, politicians and the general public who fund and use the service.

  • Trusts support the proposals to develop new standards covering a broader range of mental health services. This is 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 support more effective models of care. Trusts are also positive about the ambitions set out in the 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.

  • Debate on changing the standards has focused on the higher profile accident and emergency four-hour and elective surgery 18-week standards. While there are common features involved in changing any individual standard, the reality is that each individual potential change needs to be examined on its own merits and will have its own set of relevant factors. It is important that any debate on potential changes does not default to a generic 'lowest common denominator' conversation about change in general or pretend that talking about changing the four-hour A&E standard is an adequate proxy debate for any other change.

  • NHS Providers believes trust leaders will support any change to the standards, as they did with the ambulance standards and the introduction of mental health standards, if five key conditions are met:
    1. There is a strong, clear, and widely supported, clinical case for change.
    2. New standards are meaningful to patients and the public.
    3. Trust leaders are fully involved in the design, consideration and implementation of any changes.
    4. Implementation planning is realistic and honest about what resource and time is needed to make any change, taking full account of the current operationally challenged context.
    5. It is demonstrably clear that the changes are not an attempt to abandon the inherent performance in the current standards and that there is a credible, fully funded, agreed, plan to recover those inherent performance levels.