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Keir Starmer will attempt to reset his premiership next week by setting out a series of radical NHS changes aimed at reducing waiting times for millions of patients in England.
The shake-up comes after a torrid first six months in government and amid mounting frustration among patients. More than 6 million are waiting for care.
Under the new plans, patients will be able to get direct referrals for tests and scans for a range of ear, nose and throat, gynaecological, urological, bowel and lung conditions – without seeing a consultant first.
Thousands of patients in England will also be offered a “same-day service”, with follow-up consultations on the same day as their scans or tests, enabling more people to start treatment or get the all-clear quicker, the prime minister will announce.
In addition, a major expansion of ringfenced elective capacity in the NHS will mean routine care such as hip and knee replacement surgery will be protected from winter pressures and future pandemics.
Ministers hope the NHS changes and a series of other new year announcements will correct months of drift and set a clear course of direction for the Labour government.
However, senior doctors said they were not convinced Starmer’s plans would work because the NHS workforce crisis meant there was “insufficient” staff to bring waiting lists down any time soon.
Some also warned that without an equally focused effort to rescue NHS urgent and emergency care, which is causing some hospitals to be overwhelmed, the prime minister’s plans to improve routine care were “deluded” and doomed to fail.
Though Rachel Reeves’s budget promised an extra £22bn over the next two years to help cut waiting times, most NHS trust bosses remain sceptical.
A recent survey by NHS Providers found that 71% of the leaders overall, and 100% of those who run acute and ambulance trusts, thought it unlikely that they could make progress by 2029.
The elective change plan, expected to be unveiled on Monday, comes after Starmer made a public pledge that, by July 2029, 92% of patients would be seen within 18 weeks.
At the moment, fewer than 60% of operations or other procedures occur within an 18-week period. The target has not been met for almost a decade.
Under the changes, hundreds of thousands of patients will be able to get direct referrals for checks through their GP for conditions including breathlessness, asthma, post-menopausal bleeding, hearing loss, tinnitus, urological conditions and bowel issues, removing the need to see a consultant first.
Speeding up diagnoses will help cut waiting lists because four in five patients come off the list after a diagnostic test or an outpatient appointment.
Hospitals will also be ordered to ensure patients are as fit and prepared as possible for an operation while they wait, the Guardian understands. Officials believe this will not only boost patients’ post-operation outcomes and speed up recovery, but also cut the number of “on-the-day cancellations” and post-operation follow-up appointments.
Patients waiting for surgery will be offered support to lose weight and stop smoking while they wait, with evidence showing that quitting tobacco four weeks before an operation can reduce the risk of respiratory and wound healing complications by up to a third.
Non-clinical frontline staff such as GP surgery receptionists will also undergo compulsory “customer service” training, and hospitals will appoint patients’ experience champions so those on waiting lists are kept fully up to date and supported while they wait.
The chief executive of NHS England, Amanda Pritchard, acknowledged that “too many people” were “waiting unacceptably long for care”, with one in nine people in England on a waiting list.
However, she said that NHS staff had made “huge progress” in reducing long waits since the Covid crisis and she was convinced that they “can significantly reduce waiting times across the country again”.
“By making it easier for people to get timely access to the tests they need alongside direct referrals and same-day checks and consultations, this plan will help thousands more people to get a faster diagnosis and quicker treatment or the all-clear, so people can get back to living their lives as soon as possible, with peace of mind that they won’t need further treatment.
“The reforms set out in this plan are focused on improving how people access and experience routine care, as much as they are about waiting times. We are determined not to hit the target but miss the point. Simply put, this is a plan with patients at its heart.”
However, Dr Tim Cooksley, a former president of the Society for Acute Medicine, which represents hospital doctors, expressed concerns about the plan.
“The innovative elements of the elective recovery plan are welcome. Direct access to services, reducing bureaucracy and streamlining processes are key implementations for NHS recovery. However, the grave concern is that this fails to recognise that, without emergency care recovery, this elective plan will inevitably and predictably fail.
“There is insufficient workforce and capacity to meet the demands of an increasingly ageing population with multiple health issues, with simply no resilience to cope with any excess strain, such as winter viruses.
“Hospitals are already bursting at the seams. The concept of continuing to ringfence elective beds whilst patients are dying, receiving degrading corridor care in emergency departments, is immoral and deluded.”
A coordinated whole-system approach, including social care, focusing on increasing capacity and workforce was essential, Cooksley added. “Without this, there will be continued disappointments, suffering and cancellations for patients awaiting elective care and distressing, delayed care for those needing emergency care.”
Details of the plan emerged after official NHS figures on Friday showed the health service was under enormous strain.
The number of people admitted to hospital with flu in England has quadrupled in a month, as health leaders said “huge” pressure in the NHS would only get worse as temperatures plummet this weekend.
Sarah Arnold, the senior policy lead at the King’s Fund, said: “The English NHS, already under-bedded and under-staffed in comparison with similar health care systems in other countries, is consistently running near to full capacity.”
While seasonal illnesses put pressure on the NHS every winter, it was “worrying” that this year the flu season had started earlier, and beds occupied because of flu were already “significantly higher” than at any point in the winter season last year, she added.
