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Central priorities

On 27 March, NHS England published the , which sets out the key objectives for the health system and actions to be taken at national, Integrated Care System (ICS), and provider levels. As in the 2023/24 guidance, the central aim for the NHS “remains the recovery of core services following the Covid-19 pandemic.”  

The guidance sets out three core priorities: 

1. Recovery of services – System recovery plans must set out actions to recover elective, emergency, and primary care services. The guidance is clear that these plans should reflect the needs of children and young people as a distinct group. 
2. Supporting the workforce through improvements to staff experience and retention. 
3. Improving productivity by reducing unnecessary processes, discharge delays and agency spend.  

The guidance explains that the NHS has made significant progress over the last year by improving elective recovery, waiting times, and service capacity.

However, we know the picture differs for children’s health services, where recovery has been slower and average waiting times have increased. While this disparity is not recognised within the guidance, it does include specific priorities and actions to improve children’s health services, including requirements for Integrated Care Board (ICB) recovery plans to reflect the needs of children and young people, and to address 52-week waits for children’s community services. 

National objectives and key metrics 

The guidance sets out 32 national objectives which will determine how performance is assessed for 2024/25. This maintains the significant reduction in national targets from last year’s guidance (from over 120 to 30). 

The objectives cover emergency care, primary care, elective services, cancer pathways, diagnostics, quality and safety, mental health, learning disability and autism, prevention, maternity, resource use and workforce, and most of the objectives are all-age. 

This year, there are new objectives for community health services and prevention/vaccination, which signals a broader focus beyond acute care.

The objectives which specifically relate to the care of children and young people are: 

• ‘Increase vaccination uptake for children and young people year-on-year towards WHO recommended levels.’ 
• ‘Increase the number accessing children and young people’s mental health services (345,000 additional CYP aged 0-25 compared to 2019.)’ [carried over from 2023/24] 
• ‘Ensure 75% of people aged 14 and over on GP learning disability registers receive an annual health check in the year to 31 March 2025.’ [carried over from 2023/24] 
• ‘Reduce reliance on mental health inpatient care for people with a learning disability and autistic people to the target of no more than 15 under-18s for every 1 million population.’ [carried over from 2023/24] 
• ‘Continue to address health inequalities and deliver on the Core20PLUS5 approach, for adults and CYP.’ 

Actions for systems

The guidance includes a set of actions that systems should implement to deliver on the above objectives. Key actions for children’s health services are below: 

Quality and patient safety 

• Implementation of Martha’s rule will start in 2024, and NHSE will “support participating provider sites to devise and agree a standardised approach.” More information can be found about the roll out of this on .  

Urgent and emergency care  

• The guidance focuses on the ‘high impact initiatives’ previously set out in the ‘Delivery Plan for recovering UEC services’, which the College responded to. Systems are asked to expand capacity, improve patient flow, and shift activity away from acute hospitals. 
• There is a welcome focus on preventing unnecessary admission by strengthening advice and support in primary and community services.
• Systems are asked to “ensure that patients with mental health needs and children and young people are explicitly included in the plans to recover [UEC] services. For children and young people, [actions] include paediatric virtual wards, paediatric SDEC, and implementation of the standardised Paediatric Early Warning System (PEWS).” 

Primary-secondary care interface 

• Actions to improve primary care focus on expanding Pharmacy First, implementing Modern General Practice Access, and building primary care capacity. 
• The guidance emphasises the importance of improving the interface between primary and secondary care in order to recover services and improve efficiency. Every Trust should establish a lead for the primary-secondary care interface, and ICBs should regularly review progress to improve join-up and reduce unnecessary referrals. 

Community services  

• Systems have been asked to “develop a comprehensive plan by June 2024 to reduce the overall waiting times for community services, including reducing waits over 52 weeks for children’s community services.” 
• Actions are also identified to improve data capture and data flows across community services, and to implement annual sight and dental checks in special schools. 

Elective care 

• All providers must now eliminate 65-week waits for all age groups by 30 September 2024. 
• Systems should reduce their overall waiting lists and improve productivity, including by meeting 85% day case and theatre utilisation expectations, and prioritise actions to reduce the wait for a first appointment. 
• The guidance explains that the capacity required to deliver these improvements should largely come from implementing patient-initiated follow-up (PIFU). 

Mental health  

• Systems “must focus on recovering performance on the existing waiting time standards for CYP Eating Disorder services.”  Improvements will be supported by an additional £70 million of service development funding for CYP services, and further training for the child health workforce. 
• Systems should also focus on actions to tackle long waits for children and young people with mental health needs in urgent and emergency care.  

Embed measures to improve health and reduce inequalities  

This year’s guidance includes a greater focus on measures to prevent ill health, including through increasing childhood and flu vaccination uptake. Systems should:  

• Implement local MMR vaccination plans. 
• Establish collaborative working arrangements for vaccination commissioning so they are fully prepared for delegation of functions in April 2025.  
• Put plans in place to maximise uptake of childhood vaccinations and flu vaccinations for children and young people. 
• Support the development and improvement of Child Health Improvement Services (CHIS) IT Systems.

We look forward to seeing how the objectives related to children and young people are taken forward locally by Integrated Health Boards (ICBs) and are reflected in their refreshed Joint Forward Plans.

Members in England may wish to contact their ICB or Trust Leads to find out how they are planning to take forward these actions.