Recommendations & Conclusions
23 items
2
Recommendation
Forty-Fourth Report - NHS backlogs and …
Accepted
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 billion for elective care recovery and £5.9 billion for capital …
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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 billion for elective care recovery and £5.9 billion for capital between 2022–23 and 202425. Government expects that this additional funding will enable elective care activity to be 30% higher than pre-pandemic levels. However, the Department and NHSE&I have not set out in meaningful detail what the money will be spent on. NHSE&I is planning for 566 more elective care beds, but this appears to be a small number compared with the scale of the problem. Recommendation: In implementing its elective recovery plan, NHSE&I should set out clearly: • timeframes, costs and outputs of the components of the recovery plan covering elective care and cancer care to 2024–25; • the longer-term investments and plans that are being made now to improve the resilience of elective care and cancer care beyond 2024–25; and, • the national performance levels expected in each year between now and 2024–25.
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Government response AI 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 …
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HM Treasury
3
Recommendation
Forty-Fourth Report - NHS backlogs and …
Accepted
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 2 or 3 years before there is a material increase …
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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 2 or 3 years before there is a material increase in NHS capacity as a result of the changes it plans to elective care. Large numbers of people waiting for so long 6 NHS backlogs and waiting times in England presents a huge risk to primary care and emergency services (such as general practice and A&E) because unmet health demand can result in more GP appointments and more medical emergencies. Evidence from the University of Manchester’s Voices of COVID-19 project highlights the concerns of frontline NHS staff regarding the public dissatisfaction they face and the NHS’s lack of capacity to deal with backlogs of care. The Department and NHSE&I need to ensure the NHS workforce is adequately supported and that its service recovery planning is integrated with its planning for staffing and other types of resources. Recommendation: In implementing its recovery plan NHSE&I’s should publish its assessment of how the size of the NHS workforce (GPs, hospital doctors and nurses) will change over the next three years, so that there is transparency about the human resources that the NHS has available to deal with backlogs.
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Government response AI 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 …
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HM Treasury
4
Recommendation
Forty-Fourth Report - NHS backlogs and …
Accepted
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 healthcare in the pandemic. NHSE&I is concerned about those people …
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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 healthcare in the pandemic. NHSE&I is concerned about those people who have avoided or been unable to obtain healthcare during the pandemic. This includes the estimated 240,000 to 740,000 missing urgent cancer referrals since February 2020. There is also the huge challenge of communicating effectively with the 6 million people already waiting for elective care and providing them with support that they may require. NHSE&I expects trusts to focus on treating patients who have been waiting the longest. Recommendation: The Department and NHSE&I must ensure there is a strong focus on patient needs in all their recovery planning, including: • measuring the success of all initiatives to encourage patients to return to the NHS for diagnosis and treatment; • creating guidance and tools, and setting aside resources, for meaningful communication with patients who are waiting; and, • supporting NHS trusts through planning guidance and other means to prioritise patients fairly, so they are able to strike an appropriate balance between clinical urgency and absolute waiting time.
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Government response AI 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.
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HM Treasury
5
Recommendation
Forty-Fourth Report - NHS backlogs and …
Accepted
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 as patients in the best-performing areas to have been waiting …
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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 as patients in the best-performing areas to have been waiting over 18 weeks for elective care or more than 62 days for cancer treatment following an urgent referral. The difference between the worst and best areas in the proportion of patients waiting over 52 weeks for elective care was around 12 times. NHSE&I is expecting the same levels of improvement across NHS areas but, if this were the end result, it would mean continuing large disparities between these areas. Recommendation: NHSE&I should investigate the causes of variations between its 42 geographic areas and provide additional support for recovery in those that face the biggest challenges. NHSE&I should write to us in December 2022 on the NHS backlogs and waiting times in England 7 actions it has taken to address geographical disparities in waiting times for cancer and elective care and include a summary of any analysis it has done on differences in health outcomes for elective and cancer care in different parts of the country since the start of the pandemic.
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Government response AI 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 …
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HM Treasury
6
Recommendation
Forty-Fourth Report - NHS backlogs and …
Accepted
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 person compared with similar countries and actions taken now to …
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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 person compared with similar countries and actions taken now to increase its resources will likely take years to be realised. We are concerned that officials are too optimistic about the resilience of NHS services in the short- and medium-term, particularly as NHS staff have been working under continuously high pressure during the pandemic and the system is yet to feel the full effect of missing cancer and elective patients returning for care. The National Audit Office estimates that the elective care waiting list might grow to around 7 million people by March 2025, compared with 6.075 million in December 2021, even if the NHS manages to increase elective activity to its stated aim of 30% above pre-pandemic levels. Recommendation: The Department and NHSE&I must be realistic and transparent about what the NHS can achieve with the resources it has and the trade-offs that are needed to reduce waiting lists. In implementing its elective recovery plan, NHSE&I should set out clearly what patients can realistically expect in terms of waiting times for elective and cancer treatment. By the time of the next Spending Review at the latest, the Department and NHSE&I should have a fully costed plan to enable legally binding elective and cancer care performance standards to be met once more. 8 NHS backlogs and waiting times in England 1 Accountability and planning
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Government response AI 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 …
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HM Treasury
1
Conclusion
Forty-Fourth Report - NHS backlogs and …
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 …
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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 received and considered written evidence from 40 organisations.1
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HM Treasury
7
Conclusion
Forty-Fourth Report - NHS backlogs and …
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 …
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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 NHSE&I clarify to the Committee how NHSE should be held accountable, a recommendation with which the government agreed.11 We heard from the Department that it did not formally change the waiting times standards when waiting times performance declined before the 4 C&AG’s Report, pages 20, 27 5 NHS0040 Royal College of Emergency Medicine submission para 2 6 NHS0003 Royal College of Radiologists submission para 3 7 NHS0004 Royal College of Pathologists submission para 2; NHS 0020 Royal College of Surgeons submission para 10 8 Q24 9 Q27 10 Q26 11 Committee of Public Accounts, NHS waiting times for elective and cancer treatment, 100th report of session 2017–19, HC 1750, para 2; HM Treasury, Treasury Minutes Progress Report, CP313, November 2020, para 2.1, page 159 10 NHS backlogs and waiting times in England pandemic but it had accepted that given the pressure in the system clinicians would focus on the clinical priorities of individual patients instead.12 We asked the Department about how it planned to hold the NHS to account for the additional funding that it is now set to receive for elective recovery. An elective recovery plan had been scheduled for publication in November 2021 but had been delayed.13 The Department told us it had so far been interrupted from focussing on elective care recovery by the Omicron wave of COVID-19 but that it accepted the need for detailed plans encompassing the necessary elements of funding, capacity, workforce, organisation and clinical decision-making.14 (The recovery plan was subsequently published in February 2022).15 The Department also explained that it would continue to set the top-level measures for t
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Government response AI 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 …
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HM Treasury
8
Conclusion
Forty-Fourth Report - NHS backlogs and …
Accepted in Part
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 …
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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 not be done with the additional £8 billion of funding for elective recovery from 2022–23 to 2024–25.17 NHSE&I said there was significant uncertainty about the exact size of the future waiting list due to uncertainty over the rate at which missing referrals returned to seek care and the ongoing impact of COVID-19.18 However, it told us that in its judgement it would be very hard to reduce the size of the overall waiting list by 2025. It explained that it was more confident about reducing the number of very long waiters.19
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Government response AI summary
The government agreed with the committee's observation, acknowledging that the overall NHS waiting list is likely to worsen before improving and pointing to the existing Elective Recovery Plan. It further committed to working with NHSE&I and stakeholders to develop future funding proposals for the next …
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HM Treasury
9
Conclusion
Forty-Fourth Report - NHS backlogs and …
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 …
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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 and that the £5.9 billion of capital funding would enable a total of 9 million additional health checks, scans and procedures by 2024. More specifically, NHSE&I stated that in the second half of 2021–22 it would spend £700 million to create additional theatres, surgical hubs and diagnostic facilities and to start the separation of urgent and elective care so that urgent care is less able to disrupt elective care.20 It said these actions together would increase the number of beds available for elective care by 566 by March 2022.21 This is welcome but very small in scale: for comparison, the number of general and acute beds available daily between November 2020 and September 2021 was on average around 86,000 beds.22 12 Q28 13 Health and Social Care Committee, Clearing the backlog caused by the pandemic, ninth report of session 2021–22, HC 599, para 5 14 Q31 15 NHS England & NHS Improvement, Delivery plan for tackling the COVID-19 backlog of elective care, February 2022 16 Q100 17 C&AG’s Report, pages 36, 40 18 Q40 19 Q44 20 Qq 46, 47 21 Q43 22 C&AG’s Report, page 32 NHS backlogs and waiting times in England 11 Recovery planning and workforce
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Government response AI 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 …
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HM Treasury
10
Conclusion
Forty-Fourth Report - NHS backlogs and …
Accepted
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 …
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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 no change in nurse numbers and a reduction of 1.1% per year in the number of general and acute beds available for overnight use.23 We examined the additional capacity the NHS would require to deliver reductions in waiting lists. NHSE&I told us that additional health workers were needed across the NHS and in multiple roles. It explained that a medium-term approach was needed as time was required to recruit and train people and to get them paired with up-to-date diagnostic and other infrastructure, and that it would be two to three years before there was any material increase in NHS capacity. This increase of capacity is a prerequisite for reducing waiting lists.24
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Government response AI summary
The government agrees with the committee's observation regarding capacity needs, stating it is already addressing this through the NHS England mandate and the Elective Recovery Plan, which include targets for reducing elective care waits and improving cancer diagnosis times.
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HM Treasury
11
Conclusion
Forty-Fourth Report - NHS backlogs and …
Accepted
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 …
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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 because unmet health demand can result in more GP appointments and more medical emergencies as people try to manage or suffer the consequences of their conditions. In a survey by NHS Providers, almost all NHS trust leaders responding reported that the complexity and acuity of new patients had increased since the pandemic.25 In written evidence, the British Medical Association told us that people who were waiting might seek support from “already overstretched” GPs and that this would have a knock-on effect on the number of GP appointments available to patients seeking an initial consultation, perhaps further increasing the number of missing patients.26 NHSE&I acknowledged that it was asking GPs to do a lot at the moment.27
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Government response AI summary
The government agrees with the committee's observation of risk, detailing that its Elective Recovery Plan and the expansion of the 'My Planned Care' platform will provide better information and support to patients, including personalized waiting list advice.
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HM Treasury
12
Conclusion
Forty-Fourth Report - NHS backlogs and …
Accepted in Part
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 …
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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 with backlogs of care. The submission stated that since summer 2021 interviewees had described less tolerance from patients for delays in treatment and appointments, and patients becoming less understanding about the continued impact of COVID-19 on the NHS’s ability to provide healthcare.28 Sadly, there had also been increasing evidence of some patients complaining to and verbally abusing NHS staff. We heard from NHSE&I that it was concerned about how exhausted many NHS staff were and that it was seeking to support staff wellbeing.29 Specifically for GPs, the Department told us that it was making investments so that GPs could more quickly access specialist advice to help them support their patients.30
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Government response AI summary
The government agreed with the committee's observation, stating that better patient information and support is central to the Elective Recovery Plan and highlighted the launch and planned expansion of the My Planned Care platform to provide personalized support and information to patients awaiting treatment.
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HM Treasury
13
Conclusion
Forty-Fourth Report - NHS backlogs and …
Deferred
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 …
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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 3.7 27 Q103 28 NHS0010 University of Manchester submission para 3a 29 Q74 30 Q102 12 NHS backlogs and waiting times in England necessary long-term strategy when it came to staffing.31 Similar risks exist in the current situation. In written evidence, the King’s Fund told us that any plan to reduce waiting times needed to build explicitly from an analysis of existing staff and the potential for workforce growth alongside a realistic assessment of any scope for productivity improvements.32 31 Committee of Public Accounts, NHS nursing workforce, 18th Report of Session 2019–21, HC 408, 23 September 2020 32 NHS0007 King’s Fund submission page 4 NHS backlogs and waiting times in England 13 2 Meeting the needs of patients and the workforce
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Government response AI summary
The government agrees with the committee's observation about the risk to long-term staffing strategy, stating it is already expanding the workforce and has commissioned Health Education England to develop a Long-Term Workforce Plan, whose conclusions will be published in due course.
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HM Treasury
14
Conclusion
Forty-Fourth Report - NHS backlogs and …
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 …
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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 and cancer care. NHSE&I told us that GPs would be asked to focus on vaccinations and that people would be asked to forego some routine GP appointments. It stated that there was uncertainty over the size of any COVID-19 wave in January 2022 but that it would only cancel elective care where it had to and that it planned to keep going with high-priority emergency treatments, cancer operations and operations for life-threatening conditions.33 Patient needs
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HM Treasury
15
Conclusion
Forty-Fourth Report - NHS backlogs and …
Not Addressed
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 …
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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 in advance whether a GP appointment was routine or urgent, particularly with regard to potential cancer symptoms. NHSE&I told us that it was trying to encourage an increase in cancer referrals across the whole NHS and that it was most worried about the patients it did not know about. It urged anyone with worrying symptoms to come forward.34 We agree with this call but it does not answer our question about how patients can tell in advance of seeing a medical professional whether their problem is urgent or routine. The C&AG’s Report estimated that, as at September 2021, there were 240,000 to 740,000 missing urgent GP referrals for suspected cancer since February 2020.35
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Government response AI summary
The government agreed with the committee's observation, citing the Elective Recovery Plan's focus on better patient information and the launch of the My Planned Care platform. However, the response did not directly address the committee's specific question about how members of the public can assess …
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HM Treasury
16
Conclusion
Forty-Fourth Report - NHS backlogs and …
Accepted
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 …
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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 year would target for treatment those who have waited over two years. Over time, it would target 78-week waiters and then the 52-week waiters.37
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Government response AI summary
The government agreed with the committee's observation, reinforcing that NHSE&I's intentions are part of the mandate for NHS England and the Elective Recovery Plan, including targets to eliminate two-year waits by July 2022 and achieve 75% 28-day cancer diagnosis by March 2024. The Secretary of …
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HM Treasury
17
Conclusion
Forty-Fourth Report - NHS backlogs and …
Accepted
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 …
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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 their position on waiting lists. NHSE&I explained that it has been trying to get NHS commissioners and providers to review regularly whether patients’ clinical priority had changed and to have conversations with patients. NHSE&I accepted that these approaches had not been working as well as they should in all parts of the system; it said it wanted to build the capacity for more reviews in future.38 In evidence submitted to us, the British Heart Foundation stated that services should be appropriately resourced to support patients to self-manage and improve their 33 Q32 34 Q76 35 C&AG’s Report, page 4 36 NHS England’s published waiting times statistics for December 2021 37 Q71 38 Q103 14 NHS backlogs and waiting times in England wellbeing while they waited for treatment; this could not just be about patients being left to fend for themselves but meant regular contact, including timely updates on delays, and signposting to relevant services.39 Geographical disparities
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Government response AI summary
The government agreed with the committee's observation, stating that better information and support for patients is a key part of the Elective Recovery Plan and highlighting the launch and planned expansion of the 'My Planned Care' platform to provide personalized information and support to patients …
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HM Treasury
18
Conclusion
Forty-Fourth Report - NHS backlogs and …
Accepted
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 …
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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 days for cancer treatment following an urgent referral in the worst-performing area compared with the best-performing. The difference between the worst and best areas in the proportion of patients waiting over 52 weeks for elective care was around 12 times.40
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Government response AI summary
The government agreed with the committee's observation, describing existing work including demand modelling, providing tools to regions for activity planning, publishing cancer referral data, and offering support through regional cancer teams and the GIRFT programme to address variation and reduce backlogs.
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HM Treasury
19
Conclusion
Forty-Fourth Report - NHS backlogs and …
Accepted
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 …
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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 large disparities reflected different levels of demand for healthcare across the country.41 The Health Foundation, in written evidence, stated that, on average, the most socio-economically deprived areas of England faced the biggest backlogs and patients in those areas consequently faced longer delays.42
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Government response AI summary
The government agreed with the committee's observation, describing existing work including demand modelling, providing tools to regions for activity planning, publishing cancer referral data, and offering support through regional cancer teams and the GIRFT programme to address variation and minimise backlogs.
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HM Treasury
20
Conclusion
Forty-Fourth Report - NHS backlogs and …
Accepted
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 …
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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 end of 2021–22. It accepted that some areas of the country would struggle more than others to do this and said that it was working on mechanisms to build additional capacity, modify and change health systems and how areas could help each other across the country – including, for instance, by moving clinical teams or patients between regions.43 We also heard from NHSE&I that its elective recovery plan would consider how it could help the whole country to recover at a similar pace, even though areas are starting from different positions.44 The Department considered that transparency of performance data would be a crucial tool in reducing disparities.45 Communicating with people and patients
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Government response AI summary
The government agreed with the committee's observation and described ongoing work including demand modelling, providing tools to regions for activity planning, publishing cancer referral data, and offering support through regional cancer teams and the GIRFT programme to reduce long waits and disparities.
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HM Treasury
21
Conclusion
Forty-Fourth Report - NHS backlogs and …
Accepted in Part
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. …
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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. It said that the NHS needed to be training more staff and that it was considering how training capacity could be expanded.47 39 NHS0031 British Heart Foundation submission 28d 40 C&AG’s Report, pages 24, 29 41 Q90 42 NHS0044 The Health Foundation submission page 3 43 Q93 44 Q92 45 Q94 46 C&AG’s Report, page 31 47 Q69 NHS backlogs and waiting times in England 15
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Government response AI summary
The government agreed with the committee's observation, referring to the Elective Recovery Plan which includes multi-year capital investment in diagnostics, elective capacity, and technology. It committed to delivering up to 100 more Community Diagnostic Centres across the country by 2025 to increase diagnostic capacity.
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HM Treasury
22
Conclusion
Forty-Fourth Report - NHS backlogs and …
Acknowledged
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 …
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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 might return but it agreed to do all it could to plan realistically.48 But it also focused mostly on optimistic scenarios for the future. It told us that if demand was “at the better end of the spectrum” and it “did not have disruptions like those we are going to potentially have in the next few weeks” then the NHS would have “a really good run” at reducing waiting lists.49 We asked whether enough long-term resilience was being put in place to deal with known and unexpected risks. NHSE&I told us that one of the biggest known risks was annual winter disruption to elective care and that it was working to address this in the current planning process. Longer-term resilience would be underpinned by a workforce of the right size, the right estate and capital support, and digital transformation, as well as necessary reforms to social care.50
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Government response AI summary
The government agrees with the committee's observation regarding realistic planning, stating it acknowledges the waiting list will worsen before improving. It references the existing Elective Recovery Plan for understanding future demand, with further updates to be provided later in the year.
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HM Treasury
23
Conclusion
Forty-Fourth Report - NHS backlogs and …
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 …
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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 were compounded by the fact that staff were exhausted by their experience of the past 18 months, with the NHS Staff Survey for 2020 showing that 44% of staff reported feeling unwell as a result of work-related stress, the highest result over the past five years.52 This is the situation before the health system begins to feel the full effects of missing cancer and elective patients returning for care. Under a plausible scenario of 50% of missing patients returning and the NHS achieving a 30% increase in activity by 2024–25 compared with pre-pandemic levels, the National Audit Office estimates that the waiting list will be 7 million in March 2025, around one million higher than it was in December 2021.53 As noted by The King’s Fund, national leaders will need to decide which areas to prioritise and be honest with the public about the knock-on effects of the care they can expect to receive.54 48 Q106 49 Q107 50 Q111 51 Q72 52 NHS0044 The Health Foundation submission page 6 53 C&AG’s Report, page 36 and published NHS waiting times statistics 54 NHS0007 King’s Fund submission page 5 16 NHS backlogs and waiting times in England
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Government response AI 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 …
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HM Treasury