Policy paper

Our plan for patients

Published 22 September 2022

This was published under the 2022 Truss Conservative government

Ministerial foreword

Patients are my top priority. Purposefully, this plan is ‘Our plan for patients’.

The NHS has rightly been recognised with the award of the George Cross and the admiration of the British people, particularly for getting us through COVID-19. Most of the time, patients have a great experience, but we will not paper over the problems that we face.

Some of our challenges have been exacerbated by the pandemic, and we expect backlogs to rise before they fall as more patients come forward for diagnosis and treatment.

As we face these immense challenges, I am determined to be the champion of the patient and focus the NHS and social care on how best to deliver for them.

My approach is to trust and empower to deliver. I will be proactive, not prescriptive, with a relentless focus on measures that affect most people’s experiences of the NHS and social care. This could be putting more information at the fingertips of patients or freeing up the time of clinicians. We have listened and we are responding by removing various reasons that healthcare professionals say are holding them back from what they do best: caring for patients.

This plan sets out a range of measures to help the NHS and social care perform at their best for patients. To succeed, we need a national endeavour. That could involve clinicians who have retired to return to work or opening up opportunities for the million people who volunteered to help during the pandemic, like becoming community first responders or Good Neighbour Scheme leaders.

Our plan will sit alongside the NHS Long Term Plan, the forthcoming workforce plan, and our plans to reform adult social care. It shows the concrete steps we are taking across several areas that matter to patients and people who draw on care and support, like creating more appointments in general practice, and getting more staff on the frontline.

This plan is a first step on an important journey. It clearly shows our commitment to putting patients first; using insights from data to deliver better services across the country. While we are not being prescriptive, we will share best practice in order to improve outcomes for patients.

The data shows that sadly there is too much variation in the care people receive – dental deserts; discharge delays; ambulance delays. I will endeavour, through a powerful partnership with the NHS and local authorities, to level-up and match the expectations that the public rightly have. Whether you live in a city or a town, in the country or on the coast, this government will be on your side when you need care the most.

Rt Hon Thérèse Coffey MP
Secretary of State for Health and Social Care

Our plan for patients

Patients, and those who draw on care and support, are our top priority and key to that is helping them receive health and adult social care as quickly and conveniently as possible.

The NHS and social care help bring people into the world, are often there at the end of our lives, and we want to make sure people receive the best possible care whenever they need it. That means having a general practice (GP) appointment or being diagnosed in a timely manner, receiving treatment quickly when required and being cared for in your own home when living with a disability. We can help people to be better informed about how to prevent the need for healthcare in the first place and how to readily access healthcare through various pathways, and equip them to make informed choices with an expectation of the service that will be provided to them.

We will make performance within primary and secondary care more transparent. We will not be prescriptive with high performing practitioners, though we will continue to help all to be more productive to help patients, including by opening up other routes to access healthcare. We will make it easier for people to work in and support the NHS. We will shift the balance of funding between health and social care, so people experience a seamless care journey that meets their needs. This focus on patients will empower everyone with the information they need to make their own choices and underpin a proactive approach to improving performance.

We will help achieve this by focusing relentlessly on ABCD – ambulances, backlogs, care, doctors and dentists. While health and social care services do many things beyond these, people receiving the care they need, where they need it, at the right time for them, will lead to smoother pathways and meet public expectations.

Patients: informed and empowered

We will inform and empower patients to play a full part in decision-making about their health and treatment, by publishing easy-to-use data and performance indicators about how their local NHS is performing, such as on waiting lists for elective care and general practice appointments. Transparent data not only empowers individuals, but also helps health and care staff learn from the high performers around them about how to improve the care they deliver to patients. We will also inform patients on alternative pathways for their own care and reducing the need to use the NHS at all.

Prevention: supporting healthier lives

We know that a lot of poor health is preventable, and that people want to be, and to stay, healthy. We will move prevention services closer to the patient, continuing with innovations such as mobile breast screening units and home blood pressure monitoring, and help people reduce the risk of common conditions such as cardiovascular disease and type 2 diabetes.

We want to strengthen resilience and the health of the nation, in particular mental health and wellbeing. We will expand mental health support for children at school, given that half of mental health conditions take root by the age of 14. We will support people to start, stay and succeed in employment to benefit both the individual directly and the wider economy through increased labour market participation and productivity.

Primary care: meeting public expectations

Most people experience the NHS through primary care: general practice, pharmacies, opticians and dentists. Good primary care is the foundation of an effective health system for patients. When working well, it supports the early identification of serious illnesses and the management of chronic conditions, while also helping people to live healthier lives. Getting patients in to see their GP, dentist or practice nurse is therefore front and centre of our plan.

We will:

• set the expectation that everyone who needs an appointment with their practice within 2 weeks can get one
• prioritise so patients with urgent needs are seen on the same day, including opening up time for more than a million extra appointments over winter
• make it easier to contact your practice, by making an additional 31,000 phone lines available for GP practices
• inform patients by publishing data on how many appointments each GP practice delivers, and the length of waits for appointments, to enable patient choice
• require the local NHS (integrated care boards) to hold practices to account, providing support to those practices with the most acute access challenges to improve performance

Prioritising primary care will benefit most people who use the NHS. Hospitals will be better able to deal with serious illness earlier and to focus on more acute need rather than admissions for chronic illnesses that have not been well managed at an earlier stage.

Performance and productivity: partnership with NHS England

Delays to accessing care across the rest of health and social care are a key concern for patients. Many delays are at the points in the system where patients move from one care setting to another: from ambulance to hospital, from emergency department to ward and from hospital to a place for recovery at home or in a care home.

In order to deliver improvements in care, we are prioritising action across 4 key areas:

• ambulances
• backlogs
• care
• doctors and dentistry

Ministers and the department will forge a powerful partnership with NHS England to proactively improve outcomes for patients, holding the frontline to account and supporting them to achieve.

Ambulances

Ambulance services are often the frontline of the NHS for those who most need help urgently. Supporting ambulance services to operate more effectively is key to our plan for this winter and next. For ambulances to operate successfully, the whole urgent care pathway needs to be improved, including discharge. In winter 2021, 45% of ambulance handover delays occurred in 15 hospital trusts.

We want shorter response times for Category 1 and Category 2 incidents, enabled by quicker handover of patients so ambulances can get back on the road and respond to 999 calls.

Delivering urgent care in the most appropriate setting to all patients who need it

We are:

• working with NHS111 and ambulance services so that patients are directed to the full range of services, for example having access to dedicated 24/7 helplines for patients experiencing a mental health crisis
• supporting the NHS to better redirect patients to the most appropriate setting for them, such as urgent care centres, walk-in centres or minor injuries units
• expanding the use of remote monitoring of patients at home, where it is safe to do so, so that fewer people need to be admitted to hospital and instead receive care in their home
• supporting the local NHS to expand falls prevention and falls response services, to avoid unnecessary ambulance call-outs and emergency admissions

Answering patient calls more quickly by recruiting more 111 and 999 call handlers

We are increasing the number of call handlers to 4,800 in NHS 111 and 2,500 in 999 by December 2022. This will help with the answering of 111 calls and dispatch of ambulances for those in greatest need following a call to 999.

Improving ambulance response times

We are:

• reducing the time lost to ambulance handover delays so that ambulances can get back on the road swiftly, including an expectation that all hospitals will have clear escalation arrangements for when delays occur and can deploy hospital ambulance liaison officers (HALOs) if needed
• facilitating ambulance trusts to support each other during the busiest periods, including by rolling out a new digital intelligent routing platform and where necessary sharing call handling
• exploring establishing a new ambulance auxiliary service

Creating more capacity in hospitals

This winter, the NHS will open up the equivalent of 7,000 beds so that every hospital has space to see and treat patients more quickly. This includes treating more people at home or in the community, enabled by remote monitoring.

By December 2022, we will offer COVID-19 boosters and influenza vaccination appointments to all eligible patients to prevent unnecessary hospitalisations this winter.

Backlogs

The pandemic placed unprecedented pressures on healthcare services. This has led to delays in expected treatment. The waiting list for planned care stands at around 7 million and we expect will increase as more patients come forward for diagnosis and treatment.

In February 2022, we published the Delivery plan for tackling the COVID-19 backlog of elective care, setting ambitious targets to recover services. This was backed by more than £8 billion in funding from 2022 and 2023 to 2024 and 2025 and supported by a £5.9 billion investment in capital for new beds, equipment and technology. We have already tackled waits of over 2 years.

We will make progress to reduce waits further, including eliminating waits of over 18 months by April 2023, over 15 months by March 2024, and over a year by March 2025.

Reducing waiting times by expanding capacity

In 2021, the government committed £1.5 billion for new surgical hubs, increased bed capacity and equipment to help elective services recover. We will:

• accelerate our hospital building programme so patients and staff can benefit as soon as possible from state-of-the-art facilities, by adopting project speed principles. We continue to deliver our hospital upgrade programme. 62 of our hospital upgrade schemes are patient-ready, with 48 underway
• maximise the use of the independent sector
• change elements of the NHS pension scheme to help retain doctors, nurses and other senior NHS staff, to increase capacity:
  • correcting pension rules regarding inflation
  • encouraging NHS trusts to explore local solutions for senior clinicians affected by pension tax charges, such as pension recycling
  • implementing permanent retirement flexibilities and extending existing temporary measures to allow our most experienced staff to return to service or stay in service longer

We will continue to drive progress on:

• creating additional capacity in hospitals by recruiting 50,000 more nurses by 2024. By June 2022, nursing numbers were already 29,000 higher than in September 2019. We are also increasing the number of clinical associates, for example physician and anaesthesia associates
• providing patients with quicker and more convenient access to treatment by increasing the use of virtual outpatient appointments
• enhancing the availability of mental health support, through expansion and transformation of mental health services, including access to NHS talking therapies, children and young people’s mental health services and enhanced community support for adults living with severe mental illnesses and expanded support in schools

Getting results quicker through faster diagnosis

Patients will benefit from earlier diagnostic tests closer to home, with 92 community diagnostic centres (CDCs) already up and running, in locations from local shopping centres to football stadiums. We will prioritise delivering up to 160 CDCs in total, supporting the NHS to carry out up to 17 million tests by March 2025, with capacity for up to 9 million more per year once they are all fully operational.

Prioritising patients with the greatest need

Trusts will continue to prioritise patients who have been waiting longest and those needing treatment most urgently, including for cancer.

We will review how patients are categorised to better distinguish between patients whose care is delayed for clinical reasons or for reasons of patient choice and those who are ready to be treated.

Using joined-up data and digital tools to increase patient choice and operational productivity

Patients will be able to make informed choices as a result of our work to provide as much information as possible about their length of wait for treatment, making waiting lists by speciality and by provider, more accessible.

We will increase productivity and reduce the need for patients to repeatedly share information, by enabling clinicians and managers with high quality data platforms to help manage waiting lists and improve theatre use. We will support all trusts to put electronic patient records in place by 2025.

Care

To help people get out of hospitals and into social care support, we are launching a £500 million Adult Social Care Discharge Fund. This first step will inform our further action from next year to rebalance funding across health and care, to establish a strong and sustainable social care sector with greater accountability for use of taxpayers’ money.

Improving discharge from hospital into social care

A £500 million fund will support discharge from hospital into the community and bolster the social care workforce, to free up beds for patients who need them.

The fund can be used flexibly by local health and care systems, targeting the areas facing the greatest challenges and strengthening the sector’s ability to recruit and retain staff. This will improve pathways for people to leave hospital when they are ready, and with the right care and support in place. We will hold the local NHS and local authorities to account for implementation.

Supporting more people to work in care

Ahead of this winter, we will launch the next phase of our national recruitment campaign to encourage more people to join social care. DWP will help to promote careers in adult social care to jobseekers, with improved resources for Jobcentre Plus work coaches. We are developing the knowledge and skills framework, career pathways and ongoing investment in learning and development to support progression for care workers and registered managers.

We will invest £15 million to help boost international recruitment of care workers.

Freeing-up time to allow carers to care by using IT to reduce bureaucracy

Digitised social care records release about 20 minutes per care worker per shift. Hundreds of providers have moved to digital since March 2022. We will support care providers to switch from paper to digital records and will test and scale technologies to support people to live fulfilling, independent lives for longer.

Delivering the ‘cap and means test’ social care reforms

We will work with local government to deliver the ‘cap and means test’ reforms by October 2023, learning from the 6 trailblazer local authorities starting early in 2023.

Doctors

Primary care is the gateway for patients into the NHS. While an extra £2 billion has been invested in general practice in the last 2 years, patients tell us that making an appointment in general practice has become more difficult in recent years.

We expect that patients who need an appointment with their GP practice within 2 weeks should get one, and that patients with urgent needs should be seen on the same day.

Making it easier to access general practice

We will make it easier to get through to practices by telephone for appointments and advice. We are making an additional 31,000 phone lines available for GP practices. From January 2023, we will accelerate the delivery of high quality ‘cloud-based’ telephone solutions.

We can expect to increase the number of appointments for patients by over one million by freeing up funding rules to widen the types of staff that work in general practice. This could include GP assistants and advanced practitioners. These rules will be changed from October 2022.

We will make more time available for appointments by introducing digital tools and improving IT systems to ease administrative burdens. This includes automating appointment reminder messages, consultation booking and triage responses.

We will incentivise our most experienced GPs to stay in practice by correcting pension rules regarding inflation.

We will expect the local NHS (integrated care boards) to intervene where services need to be improved.

Publishing data to help patients make informed choices

Patients will have more information available to choose the right practice for them. From November 2022, we will publish easy-to-use data showing exactly how many appointments each practice in England is delivering and how long people wait between booking an appointment and receiving one.

Launching a new community pharmacy offer, reducing reliance on GPs

We will expand the range of services available from community pharmacies, increasing convenience for patients and freeing up GP time for more complex needs of patients. Pharmacists will be able to manage and supply more medicines, without a prescription from a GP.

We will look to go further on enabling pharmacists with more prescribing powers and making more simple diagnostic tests available in community pharmacy.

Dentists

In too many areas, patients struggle to make an appointment with an NHS dentist. In some areas, we see ‘dental deserts’, where securing an NHS dental appointment is currently impossible. To address this, we have already started changing the dental contract to incentivise dentists to do more NHS work and take on more difficult cases.

We want everyone seeking NHS dental care to receive it when they need it.

Opening up the NHS dental system

Those dentists who can provide more NHS care will be able do so, through more proactive management of contracts by the local NHS and the reallocation of resource to willing providers.

Within the NHS dental contract, we will make sure the right incentives are in place so that patients get the care they need. We have started by putting in place more targeted funding for dentists caring for patients with complex needs, who take longer to treat.

The local NHS (integrated care boards) will be held to account for the provision of dentistry in their areas, and their role in sharing best practice and innovative ways of commissioning and delivering NHS care.

From November 2022, it will be easier for patients to see information on the NHS website as to whether practices will treat new patients, as we will make it a contractual requirement for practices to keep the NHS website up to date.

Supporting the dental workforce

More people will be able to access care as we enhance retention of our dental care professionals providing NHS treatment. We want to see all members of the dental team, including dental therapists, nurses and hygienists working to the full extent of their professional qualifications. In October 2022, NHS England will issue guidance to those who perform NHS dentistry on how to deliver care under the contract using a wider range of dental professionals.

We are amending the law to allow the General Dental Council to simplify registration for dentists not trained in England, so that they can start practising in the NHS more quickly. We will also review the current NHS systems that authorise dentists to work for the NHS to help expand the workforce at a faster pace.

Enabling delivery

We will endeavour to honour our manifesto commitments – building hospitals, recruiting more clinicians, improving access to general practice, and fixing adult social care. We are focusing the efforts and resources of the health and care system on delivering the priorities of the public.

To achieve our priorities, we need a national endeavour, recognising the impact of the pandemic and the desire of many people to make a difference. That extends from people who are retired returning to help, building on the volunteers who are already supporting the NHS and extending this further within local communities.

We will support the health and social care system to deliver by:

• incentivising staff retention and the return of retired staff, by creating additional pension flexibilities and correcting pension rules regarding inflation
• keeping the emergency registers of health professionals for 2 more years
• recruiting more skilled staff from overseas and making it easier for qualified health professionals to practice here
• recruiting more people to work in care, both from the UK and internationally
• supporting new models of care and new roles for frontline health professionals, including expanding the number of mental health practitioners in primary care and strengthening mental health support in schools
• supporting the NHS and social care to make the most of digital technology

We will design and deliver our long-term workforce plan. We will review our education and training requirements and will come forward with proposals to meet the changing needs and expectations of patients in the future.