The government’s 2023 mandate for NHS England: what you need to know

Overview

The government set out three priorities for NHS England to support the sector to deliver:

1. Cutting NHS waiting lists and recovering performance
2. Supporting the workforce through training, retention and modernising the way staff work
3. Delivering recovery through the use of data and technology

Milestones at a glance

Priority 1: cut NHS waiting lists and recover performance

• Delivering more planned hospital activity to reduce long waits, increasing outpatient productivity and transforming pathways.
• By March 2025, 95 per cent of patients needing a diagnostic test should receive it within six weeks, supported by the continued roll out of community diagnostic centres' diagnostic capacity.
• Improving cancer outcomes, including NHS Long Term Plan ambitions around improving one-year and five-year survival for all cancers; increasing early diagnosis; expanding diagnostic capacity and giving priority to people with suspected cancer.
• Tracking the quality of life of people who are living with the disease.
• Strengthening information and processes so patients can access all providers of NHS healthcare, where they meet costs and standards; easily compare providers based on waiting times, distance and quality; and are offered minimum of five providers to choose from.
• From October 2023, patients to be able to request to move to a different provider to receive earlier treatment where it is clinically appropriate, and they choose to.
• Delivering the UEC recovery plan, including:
  • 76 per cent of patients admitted, transferred or discharged within four hours by March 2024, improved ambulance response times for Category 2 to 30 minutes over 2023/24, with improvement towards pre-pandemic levels in 2024/25
  • 5,000 more beds as part of the permanent bed base for next winter
  • 800 new ambulances, including specialist mental health ambulances, with greater use of urgent community response to reduce avoidable admissions; and urgent mental health support through 111 universally accessible.
  • Over 10,000 virtual ward beds in place by this autumn
  • Improving hospital and joint local government discharge processes for more complex discharge needs, including making sure every system has an effective care transfer hub.
  • Using the Better Care Fund to scale up capacity for intermediate care, supported by additional discharge funding of £600 million in 2023-24 and £1 billion in 2024-25, half issued via the NHS and half through local authorities.
• Improving GP access by delivering the primary care access recovery plan:
  • Patients who need an appointment get one within two weeks, and those with urgent needs are seen on the same day or next.
  • Moving practices to digital telephony, new digital tools and providing care navigation training and transformation support to all practices that require it.
  • All practices offered procurement support and signed up for digital telephony by July 2023, with 1,000 transitioned before the end of 2023, and all practices to have new digital tools made available to them by the end of 2023.
  • NHS England to develop and deliver the service specifications and patient group directions for the common condition service in community pharmacy and the underpinning IT improvements.
  • NHS England to support DHSC with negotiating funding arrangements and drive expansion of the blood pressure and contraception services by community pharmacy.
  • Reform services in dentistry, particularly in areas of need, while increasing service provision, attractiveness of NHS work and building workforce capacity.

Priority 2: support the workforce through training, retention and modernising the way staff work

• NHS England to implement actions in the NHS Long Term Workforce Plan to put the NHS workforce on a sustainable footing and meet the changing needs of patients over the next 15 years.

Priority 3: deliver recovery through the use of data and technology

• Continue the journey towards digital maturity:
  • 90 per cent of NHS trusts have electronic health records by 2023, 95 per cent by March 2025
  • 80 per cent of CQC registered adult social care providers have digital social care records in place by March 2024
  • By March 2024, all trusts should adopt barcode scanning of high-risk medical devices and submission to the national Medical Device Outcome Registry 
  • Implementing the national cyber strategy for health and social care and deliver the cyber improvement programme.
• Develop data infrastructure:
  • Delivering the federated data platform and maximising trust and ICB take up of the platforms and national use case tools.
  • Optimising the use of data to deliver better services and outcomes.
  • Maintaining the highest standards of data protection and ensure cyber resilience to maintain and build public trust.
• Transform the NHS App as the digital front door:
  • Increasing use for booking and managing appointments, repeat prescriptions, accessing patient records and access digital health therapeutics.
  • 75 per cent of all adults in England to be registered on the NHS App by March 2024.
  • Increasing uptake of AI tools to support the workforce in applying best practice.

Alongside the above objectives, the government re-emphasised the need for NHS England to continue its wider work to deliver the key NHS Long Term Plan ambitions, including:

• A three-year delivery plan for maternity and neonatal services and the children and young people’s transformation programme.
• Improving access to mental health support, increasing the number of adults and older adults accessing talking therapies, and improving the quality of care.
• Shifting to community-based care – more proactive personalised care, timely access to services, streamlined direct access and local pathways for direct referral.
• Improving access to and quality of services for learning disability and autistic people.
• Taking forward the updated Accessible Information Standard when published.
• Preventing ill health and supporting ICSs to tackle inequalities in access to healthcare.
• Developing and delivering a major conditions strategy to tackle the main causes of ill health and ensure care is patient focused.

Finally, the government set out three financial tests:

• The NHS will deliver overall revenue and capital financial balance every year.
• NHS England will ensure that all ICBs aim to deliver financial balance. Where deficits occur, an agreed recovery plan will be in place to return to financial balance over time.
• The NHS should make cash-releasing efficiency savings of at least 2.2 per cent in 2023 to 2024. Productivity to continue to pre-COVID-19 levels consistent with recovery plans. Ongoing productivity improvement is integral to workforce planning.

Analysis

The core objectives in the 2023 government mandate are sensible and already being worked towards by the health service and its leaders, continuing efforts to cut waiting lists and recover performance. This is a step in the right direction when it comes to reducing the number of centrally-driven priorities, in line with the Hewitt review. However, this approach should be built on and reflected in interactions with the system

...we will continue to emphasise the need to consider the capacity and headspace that digital (or other) transformation requires from leaders

We welcome the ambition to continue to level up the NHS’s digital maturity and infrastructure, as it is important for it to be fit for the future. This will not only reduce the administrative burden on staff, but will provide real opportunities to improve patient care through the use of new technologies. However, we will continue to emphasise the need to consider the capacity and headspace that digital (or other) transformation requires from leaders, particularly in light of efficiency asks.

We welcome the government's emphasis on transparency, choice and maximising the use of all providers of NHS healthcare to tackle the elective backlog. This includes the strengthened commitment to share information and improve processes for people to compare providers based on waiting times, distance and quality, and to be offered a minimum of five providers to choose from.

However, this will only be deliverable if the capacity is available to support it. This not only includes staffing - for which we continue to call for immediate publication of the NHS Long Term Workforce Plan, and for associated funding to be confirmed - but also, for investment in the estates and infrastructure that will allow the service to deliver. We continue to call for the government to increase the medium-term capital budget to fix the backlog and to meet the ever-increasing efficiency ask.

There were a few areas that were notable by their absence. The first is the lack of priorities centred around public health restoration, contrasted to last year’s mandate where a whole objective was dedicated to population health management, preventing ill health and tackling health disparities. Although the duty for NHS England around net zero and commitment to tackling wider issues, such as obesity, will remain, without calling it out explicitly alongside performance targets feels like a missed opportunity to boost the important shift the whole system must make to focus on promoting good health and prevention.

Despite the absence of focus on public health, we were pleased to see ambitions included around personalised and community-based care

Despite the absence of focus on public health, we were pleased to see ambitions included around personalised and community-based care. However, these must remain as important as access when planning for future workforce and capacity of primary and community-based services.

The second area absent from this year’s mandate is around the parity of esteem between mental and physical health, which was explicitly stated in the 2022 version. This is concerning as we still feel far from achieving this ambition. As a recent National Audit Office report recently flagged, we do not even have a definition of what parity would look like. Other areas of mental health were also not mentioned, including tackling the mental health waiting list or priorities around keeping people with mental health problems well and out of hospital.

Finally, the NHS’s ability to meet the priorities set out in the mandate and the various recovery strategies will continue to be affected by the extent of ongoing industrial action. A compromise solution is needed shortly for the NHS to have the best possible chance of meeting these shared objectives.

How we will be supporting members

We will continue to engage with the government and NHS England on behalf of members to represent their views and the reality of delivering services in the current environment.

We will continue to advocate for further guidance on the areas not covered and call for greater recognition of the issues highlighted in our analysis, such as parity of esteem for mental and physical health, capital investment, a focus on prevention and the publication of a fully funded long-term workforce plan. We are also working closely with the government to develop the upcoming Major Conditions Strategy, to ensure your views shape the plan to tackle the main causes of ill health and ensure care is patient-focused.

We will also continue to support members with the implementation of guidance through our networks and forums, at every level across the system.