Performance levels are not likely to improve in 2019/20, and the NHS is ready to implement the actions contained in the agreed winter plans. In the longer term, even if the way of measuring that performance changes following the clinical review of standards, the NHS needs:
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A major review of urgent and emergency care demand and capacity across the system, seeking to identify:
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reasons for current demand growth
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realistic predictions of future demand over a five-year period
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realistic assessment of future capacity needed to meet this demand, with sensible assumptions about the likely speed of demand modification and moves to integrated care where, too often in the past, over optimistic assumptions have been made
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clear plan to create the required additional capacity – where, how much and what capacity – backed by a realistically funded and workforce matched implementation plan.
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Rapid clarity on the performance levels the NHS should be working to on the urgent and emergency care pathway and associated pathways, such as mental health crisis care, with realistic recovery trajectories and appropriate funding, workforce and time to meet them. The investment required here then needs to be clearly prioritised against the other commitments in the NHS long term plan, with a clear assumption that recovery to the performance levels inherent in the current four-hour standard will take both time and a significant amount of money that would otherwise be available for other priorities.
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Rapid development and implementation of a sustainable solution to our current social care crisis with appropriate temporary extra investment to match rises in demand whilst such a solution is implemented.
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Sustainable solutions to current workforce challenges and realism of what can be delivered whilst these solutions are being deployed, since solving current challenges will take time. Particular priorities include increasing nursing numbers as rapidly as possible and stabilising primary care.
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An urgent solution to the current pensions problems for all NHS staff affected.
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Development of a multi-year capital regime to address all capital requirements across the NHS and equip the service with the infrastructure it needs to deliver the vision in the long term plan and the results of the urgent and emergency care demand/capacity review outlined above.