Recommendations & Conclusions
4 items
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
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
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