Hospitals across England will be required to give patients at least three weeks’ notice of their next operation, diagnostic test or consultant appointment under new rules designed to end what NHS leaders have described as the “farce” of invitation letters arriving after the appointment has already passed.
Sir Jim Mackey, the NHS England chief executive, has ordered all 205 NHS trusts to implement the change as part of a wider set of eight “patient experience standards” intended to improve communication with the millions of people stuck on waiting lists. The move follows growing pressure from patient organisations and a string of studies highlighting the toll that uncertainty takes on those awaiting care.
Research by the King’s Fund found that almost one in four patients were notified about their appointment after it was meant to have happened. Separate findings from the same health thinktank revealed widespread frustration, with many patients reporting that they felt “left in the dark” once they had joined the NHS waiting list. Healthwatch England, the independent patient champion, said 66 per cent of patients and carers had experienced at least one administrative problem, such as chasing test results or receiving incorrect or delayed appointment information.
Retail-style communication
In drafting the new standards, NHS England deliberately looked at how major online retailers such as Amazon and John Lewis keep customers updated on when their orders will arrive. The goal is to replicate that clarity and reliability for patients waiting for care, transforming what Sir Jim described as a system that can feel like “walking through treacle”.
The centrepiece of the new approach is the NHS App, which more than 40 million people have already installed. Under the new standards, patients will be notified through the app when a hospital specialist accepts their GP referral and when they are placed on the official waiting list. Those who prefer not to use the app will continue to receive updates by text message or letter – though letters still account for around 70 per cent of NHS communications to patients, and Healthwatch England research suggests paper letters are the least popular method for receiving health information, with face-to-face communication remaining the most preferred.
Sir Jim said the current system of communication was “clearly unacceptable”. He said: “Almost everyone has a story in their family about how navigating the NHS has been like walking through treacle, including cases where patients aren’t even sure if they’ve been referred, which is clearly unacceptable.” He urged hospitals to overhaul their communication procedures as soon as possible, adding: “If we want to keep improving patients’ experiences and satisfaction with the NHS we have to fix the basics – and that starts with how we treat people even before they arrive for treatment. Our communication with patients needs to be clear and easy to understand. We have to get away from making patients ask us multiple times to get the information they need and start delivering five-star customer service.”
The customer-service philosophy marks a deliberate shift in how the health service treats those on its books. The new standards aim to ensure that patients receive confirmation that their GP referral has been accepted, and that they know when to expect their appointment – ending the practice of letters arriving too late. NHS England hopes that treating patients more like customers will help improve public satisfaction, which last year rose from 21 per cent to 26 per cent – the first increase in seven years, attributed by the health service to the hard work of staff and a reduction in waiting lists to their lowest level in almost three years.
Patient and expert reaction
William Pett, interim director of policy and external affairs at Healthwatch England, described the new standards as “a clear signal from NHS leaders that high-quality customer service matters as much to patients as the length of their wait”. He added: “For too long, patients have told us about referral letters going missing, delayed appointment letters or feeling forgotten about altogether for months on end without news of when they will be seen. Needing medical care is stressful enough and through all the work to join up our data and invest in digital technology we are building a modern NHS fit for the future and able to make life much easier for patients to access the care they need.”
However, Pett cautioned that the real test will be in how the standards are implemented, noting they are “by no means revolutionary” but represent “simple and clear standards that should be the bare minimum the public can expect from our services”.
The scale of the challenge remains significant. As of February 2026, the NHS England referral-to-treatment waiting list stood at 7.22 million, with 62.6 per cent of patients being seen within the government’s 18-week target – far below the constitutional aim of 92 per cent. In March 2025, 190,068 patient pathways had been waiting more than 52 weeks. The 18-week target has not been met since 2016, and the elective waiting list would need to fall to 3.4 million to achieve it. Healthwatch England’s own research found that 41 per cent of patients said poor administrative experiences made them less likely to seek care in the future.