Use your ‘operational muscle’ to improve performance urges NHSE director

Sarah-Jane Marsh also warned that they should not expect their problems to be solved just by the addition of further capacity.

Ms Marsh’s comments followed the publication of an analysis by NHSE which suggests the acute sector was around 10 per cent less productive in 2023-24 than before the pandemic.

The UEC lead told HSJ that NHSE had invested in “a lot” of capacity to improve urgent and emergency care in the past year. This included more “permanent” general and acute hospital beds and more funding for community and ambulance services.

She said it was now time for the service to focus on making the best use of this extra resource: “The NHS, as a whole, need[s] to get back our operational process muscle. Increasing capacity and all those things are really important, but we’ve got to make the best use of the capacity that we’ve got.”

She continued: “That is about: making sure that our pathways, our processes, that everything, works; that we align capacity and demand; that we have teams in place at the right time; [and] the right IT systems. The answer to every problem cannot just be more capacity.”

Long A&E waits ‘most clinically important’

NHSE announced last Thursday that its controversial capital “incentives” scheme for improved emergency care performance will return this year.

Up to £150m of funding will be available for 2025-26 capital budgets for trusts which can demonstrate improved performance against the four-hour waiting time standard and category two ambulance response times. It will also be used to reduce 12-hour accident and emergency delays for the first time. 

Ms Marsh defended NHSE’s focus on the four-hour target – amid criticism from some that this year’s 78 per cent measure is “unambitious” and that it does not lead to the sickest patients being prioritised.

She said: “The NHS signed up to [this] target with the government to deliver four hours and category two response times, and that was the basis on which we got the additional funding.

“We all know the 12 hours is the most clinically important due to concerns around safety and experience. But that doesn’t mean four hours isn’t important in its own right.

“Just because metrics such as 12 hours don’t have a specific target doesn’t mean we don’t look at them and they aren’t important. Our improvement efforts and focus are on when we’ve got real issues with flow as demonstrated through 12 hours.”

At last week’s NHSE board meeting, deputy chair Sir Andrew Morris said that tackling 12-hour waits would be the service’s “next big challenge” in the run-up to the 2024-25 winter.

New incentives scheme

NHSE revealed the details of the new funding in a letter to trust and system chiefs – which also provided updates on last year’s national urgent and emergency care recovery plan.

The letter reiterated a pledge that 99,500 core general and acute beds would be open on average across the year. NHSE has also told trusts to boost frailty assessments at the front door of A&Es and clinical assessment input into 111 and 999 calls.

The NHSE letter urges a “stronger focus” on preventing avoidable hospital admissions through the use of services such as urgent community response teams. Systems are also encouraged to refer more patients directly to virtual wards. New analysis by management consultants PPL, commissioned by NHS England found that one non-elective hospital admission could be avoided by every 2.5 virtual ward admissions.

In the course of her interview with HSJ, Ms Marsh revealed that only 60 per cent of last year’s incentive scheme funding had been distributed. She said this year’s guidance would stress how the money could be spent on community, as well as acute, interventions.

NHS Confederation said the guidance marked a “subtle shift in focus away from hospital discharge to a greater focus on supporting people to stay healthy in their communities”.