Clinically led review of NHS access standards: interim report

In a report published in March 2019, NHS National Medical Director Professor Stephen Powis set out proposals for new NHS waiting times targets. The proposals covered urgent and emergency care, mental health services, cancer treatment and elective care. The report also set out plans for testing and evaluating the potential new standards, across the different sectors of care. The standards and evaluation plans were developed by a group of clinicians, drawing on clinical and operational evidence.

The report proposed new standards for mental health services. Recommendations included that there should be a 4-week waiting time for children and young people to access specialist mental health services, and for adults and older adults to access community mental health teams.

The proposals sought to simplify waiting time targets for cancer care, by testing: the faster diagnosis standard recommended by the independent cancer taskforce (28 days); a maximum of a 2-month wait to first treatment from urgent GP referral and NHS cancer screening; and a maximum of a 1-month (31-day) wait to begin treatment after ‘decision to treat’ for all cancer patients.

On urgent and emergency care, the report said that the 4-hour waiting target in A&E had brought benefits but was limited in its ability to measure the quality of patient care and experience. The report proposed replacing the 4-hour target with new standards that measured: time to initial clinical assessment; time to emergency treatment for critically ill and injured patients; overall time in A&E; and use of Same Day Emergency Care.

On elective care, the report recommended updating the existing 18-week limit from referral to treatment. The review proposed that waiting times for treatment should either be set as an average wait target or a defined number of maximum weeks. It suggested that the NHS should take on responsibility from patients for finding an alternative care provider after long waiting times, offering faster treatment elsewhere after 26 weeks of waiting – with fines for commissioners and providers once waits exceeded 52 weeks.

Progress report and further consultation

A 6-month progress report was published by the NHS National Medical Director in October 2019. This described the progress made in field testing the new standards, claiming some positive initial results. Public consultation and further evaluation of these proposals was delayed by the COVID-19 pandemic. After this, NHS England undertook separate consultations on revising urgent and emergency care, mental health and cancer standards between December 2020 and April 2022. In September 2022, Secretary of State for Health and Social Care Thérèse Coffey pledged there would be no changes to the 4-hour target for A&E waiting times.