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New Year, Same Challenges: Latest NHS Operational Planning Guidance Sets Out Priorities for The Year Ahead


The latest iteration of NHS improvement priorities and operational planning guidance follows the most challenging two-years in its history. The health service remains under significant pressure with the Omicron variant of coronavirus leading to a Level 4 National Incident being declared. 

Our full briefing is available below.

Ongoing impact of the pandemic  

The ongoing impact of the pandemic on the health service provides necessary context with an acknowledgement that delivery of the plans and priorities set out in the guidance relies on COVID-19 cases returning to a manageable level. 

Importantly, the target date for Integrated Care Systems (ICSs) to be put on a statutory footing and for Integrated Care Boards (ICBs) to be legally and operationally established has been pushed back to 1 July 2022 from its previous target date of 1 April. 

Priorities carried over form the 2021/22 guidance include tackling health inequalities and responding to COVID-19, with the additional of new antiviral treatments for the highest-risk patients. Workforce is again a priority but with more emphasis on increasing staff numbers including support from Health Education England (HEE) and regional NHSE&I teams to develop and deliver workforce plans.

Elective care recovery, outpatient transformation & mental health 

Tackling the growing elective care backlog and reducing long waiting times remains a key focus with a goal of delivering 10% more elective activity this year compared to pre-pandemic levels and 30% more by 2024/25. On waiting times systems are tasked with eliminating waits of over 104 weeks this year, except by patient choice. Waits of 78-weeks should be reduced with three-monthly reviews implemented for this group and similar reviews for those waiting more than 52 weeks from 1 July 2022.  

As of October 2021, 168,000 people were waiting for an NHS neurology appointment, and more than 3000 had been waiting more than a year.

In outpatients, by March next year systems are asked to reduce outpatient follow-ups by at least 25% compared to 2019/20. By the same deadline, systems are tasked with moving or discharging 5% of outpatient attendances to patient-initiated follow ups (PIFU) pathways and optimising referrals through increased use of specialist advice requests. 

Mental health services remain a priority with a request for systems to develop mental health workforce plans covering up to 2023/24 in collaboration with VCSOs and other key stakeholders. Expansion of children and young people’s mental health services is also noted along with steps to address the significant health inequalities experienced by people with a learning disability and/or autism. 

New Year, Same Challenges

Georgina Carr, Chief Executive of The Neurological Alliance, said:

“A year on from the 2021/22 Operational Planning Guidance, many of the challenges identified then remain. Waiting lists and waiting times for neurology and neurosurgery remain on an upwards trajectory with staff wellbeing, recruitment and retention an ongoing concern. 

The extension to the target date for ICSs to be put on a statutory footing and for ICBs to be legally and operationally established from 1 April to 1 July 2022 is welcome and necessary. Despite this, the operational shift from CCGs to ICSs and ICBs is putting additional strain on an already overstretched system. 

The focus on eliminating the longest waits and reducing waiting times across the board is positive however many were included in previous iterations of this guidance with little progress made. Targets for reducing outpatient follow-ups and to increase the use of “virtual wards” need to also be considered in relation to patient experience and optimal health outcomes. 

We will continue to engage with NHSE&I, Department of Health and Social Care (DHSC) and other parts of the system at all levels on issues including elective recovery, specialised commissioning, neuroscience transformation and outpatient transformation.  

Going forward we will continue to make the case for the necessary prioritisation of neurology and neurosurgery and hold the system and system leaders to account.” 

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