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Extended NHS obligations in 2017-18 mandate ‘well beyond reach’

The continued drive towards a seven-day NHS was confirmed by the Department for Health (DH) in its mandate to the NHS yesterday, as it was revealed that NHS England will be expected to provide weekend and evening access for almost half (40%) of the population by the end of 2017-18.

The mandate also set out a number of goals for the NHS with regards to emergency care: although the aim of treating 95% of patients within four hours remains a long-term target, the date that this is expected to be achieved has now been extended to 2020.

While hitting the overall target is listed as a 2020 goal, NHS England set out, as a 2017-18 deliverable, the desire to “co-implement the agreed A&E recovery plan with NHS Improvement and deliver aggregate A&E performance in England above 90% in September 2017, with the majority of trusts meeting 95% in March 2018”.

DH also told NHS England that it expected ambulance response time targets to be met for the most urgent calls by 2020 – targets which NHE revealed yesterday will be changed next month to allow A&E departments to cope more efficiently with enormous demand.

“We expect the NHS to deliver the Five Year Forward View (FYFV) and close the gaps in the quality of health, care and NHS finances through sustainability and transformation plans (STPs),” the mandate stated.

“For the first time, local service leaders in every part of England, both on the commissioner and provider side, have come together to develop these plans, with the aim of transforming health and care in the communities they serve.

“A number of metrics will be used to measure progress across STP footprints in delivering the FYFV, linking performance of the NHS at a local level more explicitly to national accountability.”

The department also promised to free up thousands of hospital beds by aiming to reduce bed blocking by 3.5%, which would free up around 2,000 extra beds per day.

Health secretary Jeremy Hunt said that he wanted to continue working with leaders across health and social care, arguing that the mandate “is about making real progress to deliver the care that our patients need, not only safeguarding the NHS’s immediate future but also ensuring this for generations to come”.

“I expect to see clear progress against the measures in this mandate in the months ahead,” he added.

Providers hit back at Hunt

Commenting on the government’s ambition to deliver long-term plans for the NHS, providers argued that obligations should not be extended whilst the service was already struggling to stay afloat in so many areas and in desperate need of new funding.

Chief executive of NHS Providers, Chris Hopson, said: “In our report, ‘Mission Impossible? The NHS provider ask in 2017-18’, we explain why – without additional support – the health service’s commitments for the coming year are well beyond reach.

“The NHS mandate confirms these obligations are being extended, even as it’s struggling to cope with unprecedented demand and severe financial constraints.”

The NHS Providers report also highlighted the added burden of recovering the four-hour A&E and 18-week surgery targets and called for more “realistic trajectories”.

However, Hopson did welcome “more measured language” around the A&E target in the mandate, after the deadline for the completion of this target was pushes from 2018 to 2020.

But despite this, the CEO still had doubts about whether the NHS would hit the extended target given the state of the health service, adding: “It is disappointing that a similar approach to the 18-week target appears not to have been adopted.

“Taken together with the other commitments set out in the document, the gap between demands on the health service and the resources available in the coming year remains unbridgeable. We maintain that just stabilising the deterioration in performance would be an achievement in itself.

“We estimate that this year NHS trusts are on course to have a collective deficit of £800 - £900m. Given the pressures the health service faces, just reproducing that financial performance would be a stretching target.”

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