55th Report - Reducing NHS waiting times for elective care

Select Committee
Public Accounts Committee HC 820 19 November 2025
Report Status Response document linked Recorded deadline: 19 Jan 2026

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Conclusions & Recommendations 29 items (7 recs)
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Government response
Treasury minutes: Government response to the Committee of Public Accounts on the Thirty-fifth report from Session 2024-26 · published 19 Jan 2026
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Recommendations & Conclusions

29 results
2 Conclusion
NHS England's outpatient transformation programme failed due to inadequate clinical engagement.
Conclusion
NHS England’s plans to transform outpatient services were not credible, even though it had already acknowledged that more efficient outpatient services would make a material difference to the waiting list. The outpatients transformation had aimed to free up capacity in … Read more
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3 Conclusion
Establish early data collection to track costs and benefits for new and transformed services.
Conclusion
NHS England’s approach to transformational change was deeply flawed in both monitoring of progress and the delivery of intended outcomes. NHS England’s diagnostic transformation programme displayed positive features of programme management and achieved planned increases in numbers of diagnostic tests. … Read more
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4 Recommendation
Require NHSE and Department to set out plans for elective care digital transformation and IT connectivity.
Recommendation
We are not confident that the Department is being realistic about the immense effort needed to reduce NHS elective care waiting times, and see a significant risk that digital solutions are being treated as a ‘cure- all’ as the 10 … Read more
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5 Recommendation
Require the Department to set out new plans for securing clinical engagement on outpatient transformation.
Recommendation
NHS England’s performance to date has not demonstrated that it can secure the clinical engagement that will be necessary to transform waiting lists. Clinical engagement has worked best when there been close working between national and local clinical leaders, and … Read more
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6 Conclusion
Require Department to confirm no unfunded commitments and assess costs of structural changes.
Conclusion
We are concerned that the Department for Health and Social Care and NHS England are still announcing major reforms without either delivery plans or secured funding. We do not accept that it is prudent to make a major change, such … Read more
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1 Conclusion
Committee gathered evidence on NHS England's elective care waiting time programmes
Conclusion
On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department for Health and Social Care (the Department) and from NHS England (NHSE) regarding NHSE’s management of transformation programmes to reduce elective care … Read more
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7 Conclusion
Multiple factors contribute to rising elective care demand and capacity shortfalls
Conclusion
We also received written submissions from a range of individuals and organisations including clinicians and academics, royal colleges representing medical disciplines, care providers, think tanks and charitable organisations. A full list of the written evidence we received is available on … Read more
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8 Conclusion
NHS England consistently missed statutory and recovery elective care waiting targets
Conclusion
NHSE’s 2022 recovery plan ambition was to eliminate waits of longer than a year for elective care by March 2025. Within this, NHSE aimed that no one would wait longer than two years by July 2022, that there would be … Read more
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9 Conclusion
Increased diagnostic capacity overwhelmed by surging demand, stalling waiting time progress
Conclusion
NHS England (NHSE) told us that the additional diagnostics capacity it had created had been quickly backfilled by growth in demand. Its progress on achieving the diagnostics recovery target remained stuck, with the number of patients waiting more than six … Read more
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10 Conclusion
Long elective care waiting times pose serious risks to patient health and mortality
Conclusion
We received written evidence that long waiting times can put patients at risk. Evidence from Dr Rob Findlay noted that if it is not known what is wrong with undiagnosed patients then some of them will unexpectedly turn out to … Read more
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11 Conclusion
Deprived communities and minority groups experience longer elective care waiting times
Conclusion
In July 2025 NHSE started publishing new data alongside the existing monthly Referral to Treatment Waiting Times data that showed that people from deprived communities and minority backgrounds are more likely to be waiting longer than 18 weeks for care … Read more
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12 Conclusion
NHS England failed to reduce outpatient follow-up appointments, abandoning its 25% target
Conclusion
NHSE has aimed to free up capacity in outpatient services to allow more patients from the waiting list to be seen. In 2022, NHSE set a target to reduce outpatient follow-up appointments by 25% compared with 2019–20 levels by March … Read more
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13 Conclusion
Outpatient transformation efforts failed to increase remote consultations and PIFU uptake
Conclusion
In 2022 our predecessor Committee was told by NHSE that the area where it has most potential to free up clinical time and see more patients is in outpatients services because “80% of the waiting list is tied 18 NIHR … Read more
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14 Conclusion
Outpatient transformation hampered by industrial action, under-resourcing, and organisational challenges
Conclusion
NHSE told us that it had got very close to achieving large changes to outpatients services, but a long period of industrial action had disrupted appointments and that a new plan and better clinical engagement was required.26 NHSE told us … Read more
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15 Conclusion
GP advice and guidance scheme demonstrates significant growth in specialist input
Conclusion
NHSE said that it had made progress in some areas, partly where necessity during the Covid 19 pandemic had driven the adoption of technology. NHSE highlighted the advice and guidance scheme, which allows GPs to request specialist input without going … Read more
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16 Conclusion
Department confirmed significant funding and operational numbers for diagnostic and surgical centres.
Conclusion
The Department wrote to us on 10 September 2025 to confirm that it has drawn down £2.2 billion of capital funding for diagnostic transformation and £1.04 billion for surgical hubs. It also confirmed that 122 surgical hubs were operational in … Read more
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17 Conclusion
Diagnostic and surgical hubs show activity below planned levels, failing waiting list targets.
Conclusion
The NAO report found that while CDCs are operational and have provided an increasing proportion of diagnostic activity, NHSE analysis in June 2024 showed that it would not meet waiting list targets due to a shortfall of around 3.6 million … Read more
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18 Recommendation
Diagnostic capacity rapidly absorbed by demand, compounded by confusion over surgical hub delivery numbers.
Recommendation
NHSE told us that the additional diagnostic capacity it has created has been quickly taken up by growth in demand and that the NHS was also trying to control non-elective urgent demand.37 We were told however that while it was … Read more
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19 Recommendation
Surgical hub governance structures less developed, with metrics misaligned to actual activity outcomes.
Recommendation
The NAO report found that the diagnostic programme has the most established governance structure and there was evidence of in-depth reporting, while governance was less developed for surgical transformation hubs.40 The Department told us that whilst it had previously had … Read more
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20 Conclusion
Future transformation plans heavily rely on digital technology for patient-centred care delivery.
Conclusion
The Department of Health and Social Care (the Department) told us that future plans for transformation will involve changing the way that care is delivered, including using digital technology in different ways.44 The Department said that in practice the transformation … Read more
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21 Conclusion
NHS digital transformation faces unique challenges; procurement processes hinder adoption of new technology.
Conclusion
NHSE told us that integration and record sharing across the NHS system features heavily within the 10 Year Health Plan, aiming to address a key weakness of the current system. NHSE said that digital transformation in the NHS presents unique … Read more
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22 Conclusion
Technology offers benefits, but many physicians lack essential hardware and software for remote outpatient care.
Conclusion
Evidence submitted by the Royal College of Ophthalmologists and the Royal College of Radiologists noted that technology can be used to eliminate waste in the system and prioritise patients better. However, the Royal College of Physicians told us in their … Read more
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23 Conclusion
Clinical engagement for outpatient transformation proved challenging, failing to gain support for targets.
Conclusion
NHS England (NHSE) engaged clinicians on the transformation programmes in various ways including working with representative bodies and embedding National Clinical Directors within the programmes to provide medical leadership. The surgical transformation programme benefited from in-person engagement and support from … Read more
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24 Recommendation
NHSE struggled with clinical engagement for outpatients programme, delaying reset despite slow progress.
Recommendation
NHSE told us that it had struggled to get the clinical community uniformly behind the outpatients programme and that engagement had also been highly variable from specialty to specialty. We heard from the Department and NHSE that in their view … Read more
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25 Recommendation
NHSE working to improve clinical engagement for outpatients, but the fundamental care model requires change.
Recommendation
NHSE accepted that any reform or change management programme cannot work without clinical engagement, and told us that it was now carrying out a range of activities to secure clinical support for the outpatients programme. NHSE explained that, among other … Read more
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26 Conclusion
NHSE abolition announced alongside significant cost-cutting demands on Integrated Care Boards
Conclusion
On 13 March 2025, the Government announced that NHSE would be abolished within two years and that the Department would put in place arrangements to deliver the responsibilities currently delivered by NHSE.57 On the same day, as part of our … Read more
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27 Conclusion
Expected redundancies at NHSE and ICBs forecast to achieve substantial annual savings
Conclusion
At our March 2025 session, NHSE told us that it was having discussions with the Cabinet Office and HM Treasury and that changes of this scale would require a redundancy scheme. NHSE told us that ICBs employed approximately 25,000 further … Read more
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28 Conclusion
Uncertainty persists regarding funding for NHSE and ICB redundancy compensation payments
Conclusion
In the September session, NHSE told us that the changes had been very dramatic and that a lot of work had been done very quickly to start to reduce the variation in running costs for ICBs as well as some … Read more
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29 Recommendation
Require a comprehensive impact study to accompany all large policy changes and projects
Recommendation
Reports by this Committee and its predecessors have highlighted the risks to value for money raised by sudden policy changes that are not supported by sufficient funding and planning. In 2023, the Committee reported that the decisions made by the … Read more
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