Recommendations & Conclusions
12 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
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
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