Managing NHS backlogs and waiting times in England

a) NHSE should improve its reporting indicators so it has a full set in place by the start of April 2023 at the latest. It should develop new indicators to take account of key risks (such as worsening health inequalities or health outcomes) and critical enablers within individual programmes (for instance, workforce availability, which is crucial to several initiatives).

b) Before April 2021, DHSC and NHSE should agree and publish guidance that explains clearly and fully how they define and report high-level metrics for increasing NHS activity and reducing long waits to ensure that they are transparent and consistently applied.

c) Before April 2023, NHSE should set up independent evaluations of its major elective recovery programmes so that it is actively developing the evidence base for these initiatives.

d) In Quarter 1 of 2023-24 NHSE should review the elective and cancer recovery actions it took in 2022-23, to assess progress and any unintended effects. At the same time, DHSC and NHSE should determine whether elective recovery targets and trajectories need to be adjusted, and how to allocate recovery funding, for future years based on actual performance in 2022-23.

e) During 2022-23, NHSE should publish a report to improve transparency on the progress it is making with the recovery of elective and cancer care. This should include an assessment of the results of its major recovery initiatives, including its approaches to reducing cohorts of long-waiters, CDCs, surgical hubs, outpatient transformation, and increasing specialist advice and guidance. NHSE should then consider whether the report should become annual for the duration of the recovery.

f) In 2024-25, with the benefit of two years of managing elective recovery, DHSC and NHSE should develop a long-term plan for returning elective and cancer services to a state in which legal and operational waiting time standards are met. DHSC should publish the plan so the public can understand at a high level how the recovery will continue after March 2025.