Keir
Starmer to announce radical NHS changes to cut waiting times
Exclusive:
Patients in England to get direct referrals for tests without seeing
consultant, but critics say plan is ‘deluded’
Andrew
Gregory Health editor
Fri 3 Jan
2025 18.00 GMT
Keir Starmer
will attempt to reset his premiership next week by setting out a series of
radical NHS changes aimed at reducing waiting times for millions of patients in
England.
The shake-up
comes after a torrid first six months in government and amid mounting
frustration among patients. More than 6 million are waiting for care.
Under the
new plans, patients will be able to get direct referrals for tests and scans
for a range of ear, nose and throat, gynaecological, urological, bowel and lung
conditions – without seeing a consultant first.
Thousands of
patients in England will also be offered a “same-day service”, with follow-up
consultations on the same day as their scans or tests, enabling more people to
start treatment or get the all-clear quicker, the prime minister will announce.
In addition,
a major expansion of ringfenced elective capacity in the NHS will mean routine
care such as hip and knee replacement surgery will be protected from winter
pressures and future pandemics.
Ministers
hope the NHS changes and a series of other new year announcements will correct
months of drift and set a clear course of direction for the Labour government.
However,
senior doctors said they were not convinced Starmer’s plans would work because
the NHS workforce crisis meant there was “insufficient” staff to bring waiting
lists down any time soon.
Some also
warned that without an equally focused effort to rescue NHS urgent and
emergency care, which is causing some hospitals to be overwhelmed, the prime
minister’s plans to improve routine care were “deluded” and doomed to fail.
Though
Rachel Reeves’s budget promised an extra £22bn over the next two years to help
cut waiting times, most NHS trust bosses remain sceptical.
A recent
survey by NHS Providers found that 71% of the leaders overall, and 100% of
those who run acute and ambulance trusts, thought it unlikely that they could
make progress by 2029.
The elective
change plan, expected to be unveiled on Monday, comes after Starmer made a
public pledge that, by July 2029, 92% of patients would be seen within 18
weeks.
At the
moment, fewer than 60% of operations or other procedures occur within an
18-week period. The target has not been met for almost a decade.
Under the
changes, hundreds of thousands of patients will be able to get direct referrals
for checks through their GP for conditions including breathlessness, asthma,
post-menopausal bleeding, hearing loss, tinnitus, urological conditions and
bowel issues, removing the need to see a consultant first.
Speeding up
diagnoses will help cut waiting lists because four in five patients come off
the list after a diagnostic test or an outpatient appointment.
Hospitals
will also be ordered to ensure patients are as fit and prepared as possible for
an operation while they wait, the Guardian understands. Officials believe this
will not only boost patients’ post-operation outcomes and speed up recovery,
but also cut the number of “on-the-day cancellations” and post-operation
follow-up appointments.
Patients
waiting for surgery will be offered support to lose weight and stop smoking
while they wait, with evidence showing that quitting tobacco four weeks before
an operation can reduce the risk of respiratory and wound healing complications
by up to a third.
Non-clinical
frontline staff such as GP surgery receptionists will also undergo compulsory
“customer service” training, and hospitals will appoint patients’ experience
champions so those on waiting lists are kept fully up to date and supported
while they wait.
The chief
executive of NHS England, Amanda Pritchard, acknowledged that “too many people”
were “waiting unacceptably long for care”, with one in nine people in England
on a waiting list.
However, she
said that NHS staff had made “huge progress” in reducing long waits since the
Covid crisis and she was convinced that they “can significantly reduce waiting
times across the country again”.
“By making
it easier for people to get timely access to the tests they need alongside
direct referrals and same-day checks and consultations, this plan will help
thousands more people to get a faster diagnosis and quicker treatment or the
all-clear, so people can get back to living their lives as soon as possible,
with peace of mind that they won’t need further treatment.
“The reforms
set out in this plan are focused on improving how people access and experience
routine care, as much as they are about waiting times. We are determined not to
hit the target but miss the point. Simply put, this is a plan with patients at
its heart.”
However, Dr
Tim Cooksley, a former president of the Society for Acute Medicine, which
represents hospital doctors, expressed concerns about the plan.
“The
innovative elements of the elective recovery plan are welcome. Direct access to
services, reducing bureaucracy and streamlining processes are key
implementations for NHS recovery. However, the grave concern is that this fails
to recognise that, without emergency care recovery, this elective plan will
inevitably and predictably fail.
“There is
insufficient workforce and capacity to meet the demands of an increasingly
ageing population with multiple health issues, with simply no resilience to
cope with any excess strain, such as winter viruses.
“Hospitals
are already bursting at the seams. The concept of continuing to ringfence
elective beds whilst patients are dying, receiving degrading corridor care in
emergency departments, is immoral and deluded.”
A
coordinated whole-system approach, including social care, focusing on
increasing capacity and workforce was essential, Cooksley added. “Without this,
there will be continued disappointments, suffering and cancellations for
patients awaiting elective care and distressing, delayed care for those needing
emergency care.”
Details of
the plan emerged after official NHS figures on Friday showed the health service
was under enormous strain.
The number
of people admitted to hospital with flu in England has quadrupled in a month,
as health leaders said “huge” pressure in the NHS would only get worse as
temperatures plummet this weekend.
Sarah
Arnold, the senior policy lead at the King’s Fund, said: “The English NHS,
already under-bedded and under-staffed in comparison with similar health care
systems in other countries, is consistently running near to full capacity.”
While
seasonal illnesses put pressure on the NHS every winter, it was “worrying” that
this year the flu season had started earlier, and beds occupied because of flu
were already “significantly higher” than at any point in the winter season last
year, she added.
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