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Stevens warns of increased operating waiting time ‘trade-off’ in FYFV update

Simon Stevens has admitted that some patients may face longer waiting times for non-urgent surgery, and no longer receive certain medications, as “trade-offs” so that improvements can be made to care in other areas.

Releasing the much-anticipated ‘Next Steps on the NHS Five Year Forward View’ report, the NHS England boss set out what many in the sector have already called “an ambitious plan for reform and transformation”.

However, in order to deliver improvements against a backdrop of increasing demand and “slowly rising” budgets, Stevens said: “Heading into our 70th year, public support for the NHS is as strong as ever but so too are the pressures on our frontline staff.

“Today we chart a course for practical care improvements for the next few years. We do not underestimate the challenges but, get these right, and patients, staff and the tax-paying public will notice the benefits.

With waiting times still low by historical standards but on the rise, and the budget growing – but slowly – it is the right time to take stock and confront some of the choices raised by this challenging context.

“While the NHS and the government remain committed to short waits for routine operations, our new mandate rightly recognises that there is likely to be continued pressure on waiting times for routine care and some providers’ waiting times will grow.”

He admitted that within a given funding envelope there are always limits to what the NHS can and cannot do, and that he could no longer guarantee treatment in the 18-week target time.

The “next steps” report sets four priorities for spending: improving performance in A&E, strengthening access to GP services, and delivering improvements to both cancer services and mental health.

Stevens argued that there is also no reason in principle why “extra spending on a drug treatment should automatically have a legal override so as to displace community nursing, mental health care or hip replacements – hence the new budget flexibility in the way NICE technology appraisals operate”.

The NHS England boss added that it is also right to challenge and tackle areas of waste or low-value care, as outlined by Lord Carter’s productivity review, so as to free up investment headroom for the main priorities.

The £2bn pledged by the chancellor social care to free up 2,000-3,000 hospital beds will release a large quantity of elective operating capacity, Stevens reflected.

18-week referral concern

But responding to the plan, president of the Royal College of Surgeons (RCS), Clare Marx, said: “The NHS is treating record numbers of patients with better outcomes, but it is now facing some of the biggest challenges in its history.

“Since the original FYFV we have a health service which is beginning to do more to cater for the needs of older patients and focusing more on prevention, not just treatment. Today’s report provides commendable leadership to the health service on how it needs to further change.

“Some of the initiatives announced today will help with the pressures on planned operations. It is absolutely right to look at how beds in hospitals can be made available by supporting patients to receive care and support in the community.”

She added that RCS also welcome NHS England’s plan to look at protecting planned surgery facilities from the impact of high numbers of emergency patients needing beds.

But the document also stated: “Looking out over the next two years we expect to continue to increase the number of NHS-funded elective operations. However, given multiple calls on the constrained NHS funding growth over the next couple of years, elective volumes are likely to expand at a slower rate than implied by a 92% RTT incomplete pathway target.”

Marx added concerned that the 18-week waiting times target for surgical treatment has now “effectively been jettisoned in all but name having been dropped from the list of priorities for the next twelve months”.

“NHS England acknowledges that there will be continued pressure on waiting times for routine care and some providers’ waiting times will grow,” she added.

Dr Jennifer Dixon, CEO of the Health Foundation, stated: “There’s a lot to be welcomed in this report. Despite the huge financial pressure the NHS is under, there is obvious progress in areas that matter to patients, for example cancer care and care for people with mental health problems. But the report is also honest.

“There will be difficult trade-offs ahead. Some patients may have to face longer waits for non-urgent surgery, such as for cataracts and hip operations, so that others can be seen quickly in A&E. Some patients may have delayed access to the latest NICE approved drugs, if investment is redirected to community services.”


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