Managing NHS backlogs & waiting times

Public Accounts Committee Closed Inquiry
Opened: 31 Oct 2022 Closed: 1 Jun 2023 Parliament page
As the Committee reported in March, the NHS in England was already running at close to maximum capacity before COVID-19. Pandemic disruption caused a sharp increase in waiting times and backlogs. Addressing these backlogs is a multi-faceted challenge for the NHS. In this follow up inquiry, the Committee will question … Read more
8 Recommendations
16 Conclusions
1 Report
1 Oral session
2 Letters
1 Event
Activity timeline 6 events
30 May
2023
Report published
24 May
2023
Correspondence
1 Mar
2023
Report published
19 Dec
2022
Correspondence
28 Nov
2022
Oral evidence
28 Nov
2022
Formal meeting (oral evidence session) · The Grimond Room, Portcullis House
Oral evidence sessions 1 session
28 Nov 2022
View on parliament.uk
Managing NHS backlogs & waiting time
Amanda Pritchard · NHS England Matthew Style · Department of Health and Social Care Professor Sir Steve Powis · NHS England Sir Chris Wormald · Department of Health and Social Care Sir James Mackey · NHS England
Title HC No. Published Items Response
Thirty-Eighth Report - Managing NHS backlogs and waiting times i… HC 729 1 Mar 2023 24 Responded
Recommendations & Conclusions
24 results
2 Recommendation Accepted
Thirty-Eighth Report - Managing NH…
NHS England was over-optimistic about the circumstances in which the NHS would be trying to...
NHS England was over-optimistic about the circumstances in which the NHS would be trying to recover elective and cancer care. In our first report on NHS backlogs and waiting times in March 2022, we reported our concern that “officials are … Read more
Government Response
The government agrees to revisit their planning assumptions for the recovery and publicly report any updates to targets so that patients and NHS staff can see a clear and realistic trajectory to achieve the 62-day cancer backlog target, the 52-week wait target for elective care, and, ultimately, the 18-week legal standard for elective care.
HM Treasury
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3 Recommendation Accepted
Thirty-Eighth Report - Managing NH…
NHS funding has increased, but to deliver key priorities such as elective and cancer recovery...
NHS funding has increased, but to deliver key priorities such as elective and cancer recovery it will need to be spent in the most cost-effective way. The Department has allocated £14 billion to NHSE from 2022–23 to 2024–25 specifically to … Read more
Government Response
NHS England will write to the Committee before summer recess to set out further detail on how funding available for elective recovery will be spent, together with details of its evaluation plans and initiatives to improve productivity.
HM Treasury
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4 Recommendation Accepted
Thirty-Eighth Report - Managing NH…
NHS England’s elective recovery programme partly relies on initiatives which have potential but for which...
NHS England’s elective recovery programme partly relies on initiatives which have potential but for which there is so far limited evidence of effectiveness. NHSE has expanded some programmes because it believes them to be sufficiently promising, but there is currently … Read more
Government Response
The government agrees to describe the real-world impact of community diagnostic centres, surgical hubs, increased use of the independent sector, and the advice and guidance programme and write to the committee before the summer recess to give further details.
HM Treasury
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5 Conclusion Acknowledged
Thirty-Eighth Report - Managing NH…
NHSE started 2022–23 with a strategy but spent most of the year dealing with tactical...
NHSE started 2022–23 with a strategy but spent most of the year dealing with tactical issues and its strategic and programme management of the recovery must improve. NHSE was allocated £14 billion of recovery funding in September 2021 (for the … Read more
Government Response
The government acknowledges the need to improve strategic and programme management of recovery and describes monitoring and support structures in place for providers at the highest risk and efforts to address health inequalities.
HM Treasury
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6 Recommendation Accepted
Thirty-Eighth Report - Managing NH…
The NHS’s recovery cannot succeed without comprehensive, realistic and sustainable plans for the future of...
The NHS’s recovery cannot succeed without comprehensive, realistic and sustainable plans for the future of the workforce and the capacity of adult social care. The Royal Colleges of Radiologists, Surgeons, Nursing, Obstetricians and Gynaecologists, and Ophthalmologists all submitted evidence to … Read more
Government Response
The government agrees to work with NHS England to reassess the achievability of elective and cancer recovery targets following the publication of its workforce plan in 2023 and the planned improvements to discharge of patients into adult social care and to publish the underlying assumptions of its workforce projections.
HM Treasury
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1 Conclusion Acknowledged
Thirty-Eighth Report - Managing NH…
On the basis of a report by the Comptroller and Auditor General, we took evidence...
On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health (the Department) and NHS England (NHSE) about NHS backlogs and waiting times in England.1
Government Response
The government acknowledges the committee's conclusion regarding NHS backlogs and waiting times and states their commitment to reducing cancer waiting times.
HM Treasury
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7 Recommendation Accepted
Thirty-Eighth Report - Managing NH…
In July 2022, the Chief Executive of the NHS, wrote to all Chief Executives of...
In July 2022, the Chief Executive of the NHS, wrote to all Chief Executives of NHS trusts, NHS Foundation Trusts and Integrated Care Boards stating that the 62-day cancer backlog target should be a critical priority for the remainder of … Read more
Government Response
The government agrees to revisit planning assumptions for recovery and publicly report any updates to targets for the 62-day cancer backlog, the 52-week wait target, and the 18-week legal standard, with implementation by Spring 2024. They also announced an additional £3.3 billion for the NHS.
HM Treasury
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8 Recommendation Accepted
Thirty-Eighth Report - Managing NH…
This Committee first looked at post-pandemic backlogs in December 2021, publishing our report in March...
This Committee first looked at post-pandemic backlogs in December 2021, publishing our report in March 2022. We noted that officials appeared to be planning on the basis of optimistic future scenarios and also that there was general over-optimism from officials … Read more
Government Response
The government agrees to revisit planning assumptions and publicly report any updates to targets for cancer backlog, elective care waits, and the 18-week standard, with a target implementation date of Spring 2024, and states actions have been stepped up to tackle the backlog.
HM Treasury
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9 Recommendation Accepted
Thirty-Eighth Report - Managing NH…
We asked NHSE about its optimism at the time it agreed the recovery targets.
We asked NHSE about its optimism at the time it agreed the recovery targets. It told us that its assumption about low levels of COVID-19 had turned out to be “completely wrong”. It added that this had resulted in both … Read more
Government Response
The government agrees to revisit planning assumptions and publicly report any updates to targets for cancer backlog, elective care waits, and the 18-week standard, with a target implementation date of Spring 2024, and states actions have been stepped up to tackle the backlog.
HM Treasury
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10 Conclusion Acknowledged
Thirty-Eighth Report - Managing NH…
We shared our concerns about the risks facing the NHS and its ability to deliver...
We shared our concerns about the risks facing the NHS and its ability to deliver the recovery targets and we pressed NHSE on how confident it was that it would meet the target to increase elective activity to 129% of … Read more
Government Response
The Department and NHS England have stepped up actions to tackle the backlog and the ambitions in the Delivery Plan were agreed between NHS England and the government, based on detailed modelling and available funding at the time.
HM Treasury
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11 Conclusion Acknowledged
Thirty-Eighth Report - Managing NH…
Macmillan Cancer Support and Healthwatch Suffolk submitted evidence to us containing powerful examples of the...
Macmillan Cancer Support and Healthwatch Suffolk submitted evidence to us containing powerful examples of the uncertainty, anxiety and other problems long waits cause patients. Macmillan Cancer Support told us that the impact of cancer care backlogs was being felt by … Read more
Government Response
The government states that the department and NHS England have stepped up actions to tackle the backlog since the publication of the Delivery Plan for tackling the COVID-19 backlog of elective care.
HM Treasury
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12 Conclusion Acknowledged
Thirty-Eighth Report - Managing NH…
The Department has allocated £14 billion to NHS England from 2022–23 to 2024–25 specifically to...
The Department has allocated £14 billion to NHS England from 2022–23 to 2024–25 specifically to recover elective and cancer care, comprising £8 billion of resource funding and £5.9 billion of capital funding, as described in the November 2021 Budget and … Read more
Government Response
The government announced an additional £3.3 billion for each of 2023-24 and 2024-25 and at the 2021 Spending Review, £14 billion was made available to the NHS to support Elective Recovery and NHS England will write to the Committee before summer recess to set out further detail on how funding available for elective recovery will be spent.
HM Treasury
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13 Conclusion Acknowledged
Thirty-Eighth Report - Managing NH…
We asked NHSE about whether, in its view, this would provide the NHS with sufficient...
We asked NHSE about whether, in its view, this would provide the NHS with sufficient funding, given its previous comments about the scale of the negative impact inflation had had on its budgets.26 The Chief Executive told us that it … Read more
Government Response
The government announced an additional £3.3billion for each of 2023-24 and 2024-25 to support the NHS in England. NHS England will write to the Committee before summer recess to set out further detail on how funding available for elective recovery will be spent, together with details of its evaluation plans and initiatives to improve productivity.
HM Treasury
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14 Conclusion Acknowledged
Thirty-Eighth Report - Managing NH…
NHSE has estimated that the NHS was around 16% less productive in 2021 than before...
NHSE has estimated that the NHS was around 16% less productive in 2021 than before the pandemic.29 NHSE’s internal analysis indicated that this drop in productivity was not solely due to immediate pandemic pressures, but also resulted from staff being … Read more
Government Response
The government outlines actions to increase activity, manage demand and increase productivity, stating that NHS England monitors progress and has published planning guidance.
HM Treasury
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15 Conclusion Acknowledged
Thirty-Eighth Report - Managing NH…
NHSE’s elective recovery programme includes plans for: • GPs to handle many elective cases previously...
NHSE’s elective recovery programme includes plans for: • GPs to handle many elective cases previously dealt with by hospital doctors. Instead of referring some patients for elective care, GPs manage them within the 24 C&AG’s Report, paras 7, 1.15; Autumn … Read more
Government Response
The government highlights actions in the NHS published Delivery Plan are targeted at increasing activity, managing demand or increasing productivity and NHS England carefully monitors progress against delivery targets at regular intervals.
HM Treasury
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16 Conclusion Acknowledged
Thirty-Eighth Report - Managing NH…
We asked how confident NHSE was about the component programmes in its plan, particularly those...
We asked how confident NHSE was about the component programmes in its plan, particularly those aimed at increasing elective and diagnostic capacity. It told us that it did not have strong evidence for some of its programmes at present, but … Read more
Government Response
The government outlines actions to increase activity, manage demand and increase productivity, stating that NHS England monitors progress and has published planning guidance; NHS England will write to the Committee before summer recess to set out further detail of the impact of community diagnostic centres, surgical hubs, use of the independent sector, and the advice and guidance programme.
HM Treasury
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17 Conclusion Acknowledged
Thirty-Eighth Report - Managing NH…
Surgical hubs and community diagnostic centres have potential, but success will rely on them being...
Surgical hubs and community diagnostic centres have potential, but success will rely on them being adequately staffed. NHSE currently has limited evidence on hubs’ and CDC’s ability to continue operating when the wider NHS is under significant pressure.36 The Royal … Read more
Government Response
The government outlines actions to increase activity, manage demand and increase productivity, stating that NHS England monitors progress and has published planning guidance; NHS England will write to the Committee before summer recess to set out further detail of the impact of community diagnostic centres, surgical hubs, use of the independent sector, and the advice and guidance programme.
HM Treasury
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18 Conclusion Acknowledged
Thirty-Eighth Report - Managing NH…
We also asked NHSE whether its increased use of the independent healthcare sector might detract...
We also asked NHSE whether its increased use of the independent healthcare sector might detract from or reduce activity within the NHS itself. NHSE told us that this was a key consideration in decisions about when to use the independent … Read more
Government Response
The government outlines actions to increase activity, manage demand and increase productivity, stating that NHS England monitors progress and has published planning guidance; NHS England will write to the Committee before summer recess to set out further detail of the impact of community diagnostic centres, surgical hubs, use of the independent sector, and the advice and guidance programme.
HM Treasury
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19 Recommendation Accepted
Thirty-Eighth Report - Managing NH…
We asked NHSE about its programme management of the recovery and its strategic approach to...
We asked NHSE about its programme management of the recovery and its strategic approach to tackling variation in performance between NHS areas. The National Audit Office found that, whilst recovery funding was allocated in September 2021 and the recovery plan … Read more
Government Response
The government agrees with the recommendation and will assess all providers based on their confidence in delivering against targets, with providers at highest risk receiving additional national support and oversight; implementation by July 2023.
HM Treasury
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20 Conclusion Acknowledged
Thirty-Eighth Report - Managing NH…
NHSE told us that it monitored performance constantly, with fresh data available weekly, and that...
NHSE told us that it monitored performance constantly, with fresh data available weekly, and that it was continually developing the metrics it uses to track performance. It argued that this was a comprehensive and agile approach.40 We heard how NHSE … Read more
Government Response
The government agrees and outlines actions taken, including provider assessments, additional support for high-risk providers, monitoring, and addressing health inequalities, with ICBs expected to develop delivery plans.
HM Treasury
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21 Conclusion Acknowledged
Thirty-Eighth Report - Managing NH…
In response to our question about improving areas that have seen long-term underperformance, sometimes dating...
In response to our question about improving areas that have seen long-term underperformance, sometimes dating back to before the pandemic, NHSE told us that it had sent teams into some areas to support and challenge them.42 The National Audit Office … Read more
Government Response
The government agrees and outlines actions taken, including provider assessments, additional support for high-risk providers, monitoring, and addressing health inequalities, with ICBs expected to develop delivery plans.
HM Treasury
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22 Conclusion Rejected
Thirty-Eighth Report - Managing NH…
This report is the Committee’s second on NHS backlogs, the first being published in March...
This report is the Committee’s second on NHS backlogs, the first being published in March 2022. We stated then that “the NHS will be less able to deal with backlogs if it does not address longstanding workforce issues”.44 For this … Read more
Government Response
The government disagrees with the Committee’s recommendation, but states all aspects of NHS performance, and their impact for delivery, are kept under continued review by the department and NHS England.
HM Treasury
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23 Conclusion Rejected
Thirty-Eighth Report - Managing NH…
We asked the Department if it agreed that it was more sustainable to train more...
We asked the Department if it agreed that it was more sustainable to train more doctors, nurses and other health professionals domestically, rather than be over-reliant on international recruitment. It told us that this question would be part of the … Read more
Government Response
The government disagrees with the Committee’s recommendation, but states all aspects of NHS performance, and their impact for delivery, are kept under continued review by the department and NHS England.
HM Treasury
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24 Conclusion Not Addressed
Thirty-Eighth Report - Managing NH…
We asked about other key enablers of a successful recovery of elective and cancer care.
We asked about other key enablers of a successful recovery of elective and cancer care. NHSE told us about the particular negative impact of delayed discharges into adult social care, which had reduced its effective inpatient capacity.48 The Department confirmed … Read more
Government Response
The government disagrees with the Committee’s recommendation.
HM Treasury
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Government Response AI assessment · 24 of 8 classified
Accepted 8
Acknowledged 13
Not Addressed 1
Rejected 2
Total 8 recs + 16 conclusions
Correspondence 2 letters
24 May 2023 Correspondence from Amanda Pritchard, Chief Executive Officer, NHS England, re Thirty Eighth Report on NHS Backlogs and Waiting Times: Recommendations Three and Four, dated 15 May 2023
Parliament page
19 Dec 2022 Correspondence from Sir Chris Wormald, Permanent Secretary, Department of Health & Social Care, re PAC Hearing: Managing NHS Backlogs and Waiting Times, dated 12 December 2022
Parliament page