Forty-Fourth Report - NHS backlogs and waiting times in England

Select Committee

Public Accounts Committee HC 747 16 March 2022

Report Status Government responded

Conclusions & Recommendations 23 items (5 recs)

Source View on Parliament website

Government Response (AI assessment · 8 of 23 classified)

Accepted 5

Recommendations

5 results

2 Accepted

At our evidence session the Department and NHSE&I appeared unwilling to make measurable commitments about...

Recommendation

At our evidence session the Department and NHSE&I appeared unwilling to make measurable commitments about what new funding for elective recovery would achieve in terms of additional NHS capacity and reduced patient waiting times. NHSE&I will receive an additional £8 … Read more

Government Response Summary

The government agrees with the recommendation and published the Elective Recovery Plan to eliminate waits of longer than a year for elective care by March 2025 and to have 95% of patients needing a diagnostic test receive it within six weeks by March 2025. NHSE will deliver up to 100 more community diagnostic centers across the country by 2025.

HM Treasury

3 Accepted

The NHS will be less able to deal with backlogs if it does not address...

Recommendation

The NHS will be less able to deal with backlogs if it does not address longstanding workforce issues and ensure the existing workforce, including in urgent and emergency care and general practice, is well supported. NHSE&I believes it will be … Read more

Government Response Summary

The government agrees and states that ensuring the NHS has a workforce in the right numbers and with the right skills to deliver service commitments to patients is crucial; growth of the NHS workforce continues to be a priority. It has also commissioned NHS England and Improvement and HEE to develop a Long-Term Workforce Plan to be published in due course.

HM Treasury

4 Accepted

It will be very challenging for the NHS to focus sufficiently on the needs of...

Recommendation

It will be very challenging for the NHS to focus sufficiently on the needs of patients when it comes to dealing with backlogs, both patients already on waiting lists and those who have avoided seeking or been unable to obtain … Read more

Government Response Summary

The government agrees with the recommendation and states that better information and support for patients is a key part of the Elective Recovery Plan; NHSE&I launched the My Planned Care platform and the NHS is prioritizing diagnosis and treatment according to clinical urgency.

HM Treasury

5 Accepted

Waiting times for elective and cancer treatment are too dependent on where people live and...

Recommendation

Waiting times for elective and cancer treatment are too dependent on where people live and there is no national plan to address this postcode lottery. In September 2021, patients in the worst-performing geographic areas were more than twice as likely … Read more

Government Response Summary

The government agrees with the Committee’s recommendation and has done extensive work to model a range of scenarios to better understand the levels of ‘bounce-back’ demand, also working to establish regional and national cancer teams and a national programme to improve the treatment and care of patients.

HM Treasury

6 Accepted

For the next few years it is likely that waiting time performance for cancer and...

Recommendation

For the next few years it is likely that waiting time performance for cancer and elective care will remain poor and the waiting list for elective care will continue to grow. The UK has low numbers of healthcare resources per … Read more

Government Response Summary

The government agrees with the recommendation. NHS England published the Elective Recovery Plan in February 2022 which sets out a clear vision for how the NHS will recover and expand elective and cancer services over the next three years, and what patients can expect, which allows better understanding of future demand.

HM Treasury

Conclusions (18) Observations and findings — click to expand

1 Conclusion

On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health and Social Care (the Department) and NHS England and NHS Improvement (NHSE&I) about the backlogs and waiting times for elective and cancer care in the NHS in England. We also …

7 Conclusion Acknowledged

But plans are only one part of the explanation for deteriorating performance. This Committee’s June 2019 report NHS waiting times for elective and cancer treatment concluded that the Department had allowed NHS England to be selective about which standards it focused on, reducing accountability. We recommended that the Department and …

Government Response Summary

The government agrees with the Committee’s recommendation, noting the mandate to NHS England sets out the strategic goals that the government has set for NHS England in the year ahead, including objectives on recovery of wider NHS services impacted by the pandemic, and on further delivery of the NHS Long Term Plan.

8 Conclusion

The C&AG’s Report included two plausible scenarios under which the waiting list will be even longer in 2025 than it was in 2021. One of these scenarios assumed that the NHS would achieve the 30% increase in activity that is now the government’s stated aim. We asked why more could …

9 Conclusion Acknowledged

We sought reassurance that all additional funding would be well spent and asked for examples of the measurable improvements that we could reasonably expect to see. We heard generally from the Department that with the additional £8 billion recovery funding it wanted to restore activity to the highest level possible …

Government Response Summary

The government agrees with the recommendation and published the Elective Recovery Plan which sets out the goals for tackling the elective care and cancer backlogs over the course of the next 3 years. The government plans to eliminate waits of longer than a year for elective care by March 2025, and to have 95% of patients needing a diagnostic test receive it within six weeks by March 2025.

10 Conclusion

Between 2010 and 2019 the NHS saw an average annual growth in emergency admissions of more than 3% and in urgent cancer referrals from GPs of more than 10%. Although there was relatively strong growth in the number of consultants (over 3% per year) during that period, there was almost …

11 Conclusion

The very large numbers of people who have not presented for healthcare, or were not able to obtain it, during the pandemic, as well as those who have already been on waiting lists for long periods of time present a huge risk to primary and emergency care services. This is …

12 Conclusion

The University of Manchester’s Voices of COVID-19 project has interviewed over 2,000 NHS staff to provide a national collection of testimonies in partnership with the British Library. This evidence highlights the concerns of frontline NHS staff regarding the public dissatisfaction they face and the NHS’s lack of capacity to deal …

13 Conclusion

This Committee’s September 2020 report, NHS nursing workforce, concluded that there was a risk that the NHS was focusing on short-term pressures at the expense of the 23 C&AG’s Report, page 30 24 Qq 69, 75 25 NHS0043 NHS Providers submission para 3a 26 NHS0022 British Medical Association submission para …

14 Conclusion

The Department and NHSE&I are now managing a large, growing and diverse set of challenges to elective and cancer care on top of the ongoing pandemic. We asked how the Department and NHSE&I expected the accelerated and expanded vaccine booster programme, announced on 12 December 2021, to impact on elective …

15 Conclusion

The number of missing referrals and the size of the waiting list make for a daunting situation when it comes to the needs of patients. Thinking about the recent changes to GPs’ workload to allow them to focus on booster vaccinations, we asked how members of the public could know …

16 Conclusion

There are 6 million people on the waiting list for elective care.36 NHSE&I told us it intends to focus on those with the highest clinical need and priority, and especially in the immediate period, those who have waited the longest time. For long-waiters, NHSE&I stated that its plan for this …

17 Conclusion

We asked about how patients other than the longest waiters and those with the highest clinical priority would be supported while they waited. NHSE&I stated that GPs had a role in managing these patients and that it was also asking secondary care clinicians to ensure patients were clearly informed about …

18 Conclusion

In September 2021, patients in the worst-performing of NHSE&I’s 42 geographic areas of England were more than twice as likely as patients in the best-performing areas to have been waiting over 18 weeks for elective care. Patients were also more than twice as likely to have waited more than 62 …

19 Conclusion

We asked NHSE&I to explain these disparities. It told us that the COVID-19 pandemic had had a differential effect across the country and that the differences reflected where the NHS had most diagnostic capacity and skilled workforce compared with where these resources were more stretched. It also said that the …

20 Conclusion

We asked about very long-waiters in different areas and what action NHSE&I was taking to reduce them. It told us that all areas had had the same expectation placed upon them, to attempt to reduce the number of patients who had been waiting for more than two years by the …

21 Conclusion

Among comparable OECD countries the UK has relatively low numbers of hospital beds, nurses and doctors per 1,000 population and also carries out relatively low numbers of advanced diagnostic examinations.46 NHSE&I told us that it would take two to three years before there was a material increase in NHS capacity. …

22 Conclusion

We considered whether officials were planning on the basis of realistic assessments of future demand for healthcare or whether they were being too optimistic. NHSE&I told us that there was lots of risk and uncertainty in the NHS at present because of missing patients and the rate at which they …

23 Conclusion Acknowledged

NHSE&I emphasised the flexibility of the NHS workforce, as evidenced throughout the pandemic. It said that this workforce flexibility now needed to continue as part of transforming the NHS for the future and recovering elective and cancer care.51 In written evidence, the Health Foundation told us that serious staff shortages …

Government Response Summary

The government agrees that ensuring that the NHS has a workforce in the right numbers and with the right skills to deliver service commitments to patients is crucial and is already expanding the size of the workforce, aligning workforce planning with service and financial planning and looking at the long-term strategic drivers of workforce demand and supply.