NHS Backlogs and waiting times
Closed
What the inquiry looked at
“The NHS in England was running at close to maximum capacity before the COVID-19 pandemic. The pandemic has led to a sharp drop in routine NHS activity, resulting in more people waiting for treatment, and waiting for longer . The Committee will question the senior officials at DHSC and NHS England on the current position of NHS backlogs and waiting times following the COVID-19 pandemic, including the points at which patients wait for NHS treatment; how trends in waiting times changed before the emergence of COVID-19; and the effect that COVID-19 has had on waiting times. If you have evidence on these issues, please submit it here by Wednesday 8 December.”
The committee's words, from the inquiry page on parliament.uk ↗.
What it found
At the end of December 2021, 6.07 million patients were waiting for elective care, the biggest waiting list since records began. Only 64% (3.87 million) of these patients had been waiting for less than 18 weeks, compared with the performance standard which requires 92% to have been waiting for less than 18 weeks. Similarly, in December 2021, only 67% of patients with an urgent referral for suspected cancer were treated within 62 days compared with a requirement for 85% to be treated within that time.
The Department of Health and Social Care (the Department) and NHS England and NHS Improvement (NHSE&I) oversaw declines in waiting time performance for cancer care from 2014 and elective care from 2016 as they did not increase capacity sufficiently to meet growing demand for NHS services. On top of these previous failures and despite the heroic efforts of the NHS workforce, the COVID-19 pandemic has inevitably caused a further huge deterioration in the NHS’s provision of elective and cancer care.
A striking feature of the pandemic was that very large numbers of patients did not present at, or were unable to access, routine NHS services. As of September 2021, there were between 7.6 million and 9.1 million missing referrals of patients for elective care and between 240,000 and 740,000 missing urgent referrals for suspected cancer. People will face serious health consequences as a result of delays in treatment, with some dying earlier than they otherwise would, and many living with pain or discomfort for longer than they otherwise would.
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. The Department needs to be better at communicating with NHS staff and patients about what the NHS will be able to deliver in the coming years and it urgently needs to improve its record of holding NHSE&I to account, given the additional £8 billion of revenue funding for elective recovery and £5.9 billion of capital funding. The government has told the NHS to deliver 30% more elective care activity by 2024–25 than it was delivering before the pandemic. We urge NHSE&I and the Department to be clear about what this will mean for patient waiting times and how performance may differ across the country.
Any transparent and realistic assessment of what the Department and NHSE&I expect elective and cancer care services to achieve by 2024–25 needs to include an assessment of the number of staff that will be available, how staff who have been working under intense and consistent pressure will be supported, and how patients will be kept informed about their own progress through waiting lists.
What the government said
The government responded on 27 May 2022. The deadline was 16 May 2022.
The government states that it agrees with each of the Committee's recommendations on NHS elective and cancer waiting times, with target implementation dates between Spring 2023 and Autumn 2024.
- On accountability, the government agrees, and says the Secretary of State will keep NHS England's progress under review and will lay in Parliament and publish an assessment of its 2022-23 performance "after the end of the financial year".
- On the Elective Recovery Plan, it says goals include eliminating waits of longer than a year by March 2025 (aside from specific specialties or due to patient choice), and that NHSE will deliver "up to 100 more community diagnostic centres" by 2025.
- On workforce, it agrees, and says a Long-Term Workforce Plan has been commissioned, with key conclusions to be published "in due course".
- On a fully costed plan for meeting the legal standards, it agrees (target date Autumn 2024), noting "short-term and long-term uncertainty" and saying the department will develop funding proposals for the next Spending Review period.
Read the government's response ↗ Read the report ↗ Report an error
How the inquiry ran
Each dot is a dated item listed on this page, from the inquiry's opening on 21 October 2021 to its close on 27 May 2022. The dashed mark is the deadline Parliament records for the government's response.
- Oral evidence 15 Dec 2021
- Report 16 Mar 2022
- Government response 27 May 2022
What it recommended 5 recommendations · 18 conclusions
2At our evidence session the Department and NHSE&I appeared unwilling to make measurable commitments about...
3The NHS will be less able to deal with backlogs if it does not address...
4It will be very challenging for the NHS to focus sufficiently on the needs of...
5Waiting times for elective and cancer treatment are too dependent on where people live and...
6For the next few years it is likely that waiting time performance for cancer and...
1On the basis of a report by the Comptroller and Auditor General, we took evidence...
7But plans are only one part of the explanation for deteriorating performance.
8The C&AG’s Report included two plausible scenarios under which the waiting list will be even...
9We sought reassurance that all additional funding would be well spent and asked for examples...
10Between 2010 and 2019 the NHS saw an average annual growth in emergency admissions of...
11The very large numbers of people who have not presented for healthcare, or were not...
12The University of Manchester’s Voices of COVID-19 project has interviewed over 2,000 NHS staff to...
13This Committee’s September 2020 report, NHS nursing workforce, concluded that there was a risk that...
14The Department and NHSE&I are now managing a large, growing and diverse set of challenges...
15The number of missing referrals and the size of the waiting list make for a...
16There are 6 million people on the waiting list for elective care.36 NHSE&I told us...
17We asked about how patients other than the longest waiters and those with the highest...
18In September 2021, patients in the worst-performing of NHSE&I’s 42 geographic areas of England were...
19We asked NHSE&I to explain these disparities.
20We asked about very long-waiters in different areas and what action NHSE&I was taking to...
21Among comparable OECD countries the UK has relatively low numbers of hospital beds, nurses and...
22We considered whether officials were planning on the basis of realistic assessments of future demand...
23NHSE&I emphasised the flexibility of the NHS workforce, as evidenced throughout the pandemic.
Evidence
Oral evidence sessions 1
- 15 Dec 2021NHS Backlogs and waiting times5 witnesses, listed belowparliament.uk ↗
Who gave evidence 5 witnesses
- Amanda PritchardChief Executive Officer, NHS England
- Matthew StyleDirector General for Secondary Care and Integration, Department of Health and Social Care
- Professor Stephen PowisNational Medical Director, NHS England
- Sir Chris WormaldPermanent Secretary, Department of Health and Social Care
- Sir James MackeyChief Executive, NHS England