It is entirely right that the access standards are regularly reviewed and we fully support the clinical focus of the review and the principles on which it is based. It is timely to look at what standards are fit for purpose to support the NHS in delivering the vision set out in the long term plan.
However, we must remain mindful of the need to build a broad and wide consensus about what would constitute an appropriate set of access standards for the NHS. It is vital that we have a robust and rigorous process to do that in a way that is inclusive. We feel strongly that all those who have a stake in the standards need to be part of the debate: patients, the public, politicians, clinicians, leaders and managers.
Different standards and targets will always create different pros and cons. However, as we have established in this briefing, it is also crucial that we think carefully about all the purposes that standards fulfil within the NHS while recognising the primary importance of clinical considerations. It is only right that the start of process has had a strong clinical focus but we will soon need to broaden out the process of engagement and debate to take account of the other functions which these standards fulfil and to ensure there are no unintended consequences for any stakeholders involved. This is particularly important within the broader context of the shift to measuring a wider basket of outcome-focused metrics to track the progress and implementation of the vision set out in the NHS long term plan.
NHS Providers believes trust leaders will support any change to the standards, as they did with changes to the ambulance standards and the introduction of mental health standards, if the following five key conditions are met:
- There is a strong, clear, and widely supported, clinical case for change. The changes must be evidence-based, in the interest of patients, reflect modern clinical practice; and align with the relevant clinical professional code. This will require broad support and consensus from across the clinical community including frontline staff, trust leaders and royal colleges.
- They are meaningful to patients and the public. Access standards must resonate with the patients and their families, and the wider public. These standards are key in providing information about what they public should expect from particular NHS services, and offer a means to benchmark the performance of different providers.
- Trust leaders are fully involved in the design, consideration and implementation of any changes. There should be an effort to facilitate a genuine and full debate with the hope of building a consensus across the provider sector. This must include thorough testing, wide sharing of results and the chance to fully consider what the proposed changes will look like through each of the purposes the standards fulfil as set out in this briefing.
- 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. There needs to be proper due diligence on what resource and time any changes will actually take to deliver. Any changes must be presented a part of well thought through and fully co-created implementation plan that takes full account of current operational, financial and workforce pressures. Trusts will also need adequate support in making the changes including the right IT, right staff, right resources and training where required. Frontline staff with also require clear instructions from national bodies setting out the expectations and timelines.
- 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. The case for change and accompanying plan must be clear that the new standards are ambitious and fit the long-term vision of the NHS. The plan must demonstrate how the sector can recover the inherent performance levels which have slipped over the past decade.
It is not for NHS Providers to specify what other groups of key stakeholders would require but we would assume that the public will want the ability to see a top-level summary of the NHS’ performance nationally, to understand the relative performance of their local trust and to review performance over time. The public will also need the reassurance that the NHS is not abandoning the performance levels implicit in the current standards set out in the NHS constitution. There must be adequate time for a full public consultation on any changes to the handbook because of the wide-reaching impact of the proposals. Finally, the public, parliament and the media will all want a clear, simple to understand, and rigorous performance framework that enables them to hold the NHS properly to account.
Given the fundamental and multiple functions the current standards play within the NHS – it is vital we build a broad consensus and collectively get this right.