Recommendations & Conclusions
24 items
2
Recommendation
Thirty-Eighth Report - Managing NHS bac…
Accepted
NHS England was over-optimistic about the circumstances in which the NHS would be trying to recover elective and cancer care. In our first report on NHS backlogs and waiting times in March 2022, we reported our concern that “officials are too optimistic about the resilience of NHS services in the …
Government response. The government agrees to revisit their planning assumptions for the recovery and publicly report any updates to targets so that patients and NHS staff can see a clear and realistic trajectory to achieve the 62-day cancer backlog target, the 52-week …
HM Treasury
3
Recommendation
Thirty-Eighth Report - Managing NHS bac…
Accepted
NHS funding has increased, but to deliver key priorities such as elective and cancer recovery it will need to be spent in the most cost-effective way. The Department has allocated £14 billion to NHSE from 2022–23 to 2024–25 specifically to recover elective and cancer care. This comprises £8 billion of …
Government response. NHS England will write to the Committee before summer recess to set out further detail on how funding available for elective recovery will be spent, together with details of its evaluation plans and initiatives to improve productivity.
HM Treasury
4
Recommendation
Thirty-Eighth Report - Managing NHS bac…
Accepted
NHS England’s elective recovery programme partly relies on initiatives which have potential but for which there is so far limited evidence of effectiveness. NHSE has expanded some programmes because it believes them to be sufficiently promising, but there is currently a limited evidence base for their effectiveness, their impact on …
Government response. The government agrees to describe the real-world impact of community diagnostic centres, surgical hubs, increased use of the independent sector, and the advice and guidance programme and write to the committee before the summer recess to give further details.
HM Treasury
5
Conclusion
Thirty-Eighth Report - Managing NHS bac…
Acknowledged
NHSE started 2022–23 with a strategy but spent most of the year dealing with tactical issues and its strategic and programme management of the recovery must improve. NHSE was allocated £14 billion of recovery funding in September 2021 (for the three years from April 2022) and published its recovery plan …
Government response. The government acknowledges the need to improve strategic and programme management of recovery and describes monitoring and support structures in place for providers at the highest risk and efforts to address health inequalities.
HM Treasury
6
Recommendation
Thirty-Eighth Report - Managing NHS bac…
Accepted
The NHS’s recovery cannot succeed without comprehensive, realistic and sustainable plans for the future of the workforce and the capacity of adult social care. The Royal Colleges of Radiologists, Surgeons, Nursing, Obstetricians and Gynaecologists, and Ophthalmologists all submitted evidence to us stressing the need for strategic workforce planning. In our …
Government response. The government agrees to work with NHS England to reassess the achievability of elective and cancer recovery targets following the publication of its workforce plan in 2023 and the planned improvements to discharge of patients into adult social care and …
HM Treasury
1
Conclusion
Thirty-Eighth Report - Managing NHS bac…
Acknowledged
On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health (the Department) and NHS England (NHSE) about NHS backlogs and waiting times in England.1
Government response. The government acknowledges the committee's conclusion regarding NHS backlogs and waiting times and states their commitment to reducing cancer waiting times.
HM Treasury
7
Recommendation
Thirty-Eighth Report - Managing NHS bac…
Accepted
In July 2022, the Chief Executive of the NHS, wrote to all Chief Executives of NHS trusts, NHS Foundation Trusts and Integrated Care Boards stating that the 62-day cancer backlog target should be a critical priority for the remainder of the year.13 This instruction has not led to the results …
Government response. The government agrees to revisit planning assumptions for recovery and publicly report any updates to targets for the 62-day cancer backlog, the 52-week wait target, and the 18-week legal standard, with implementation by Spring 2024. They also announced an additional …
HM Treasury
8
Recommendation
Thirty-Eighth Report - Managing NHS bac…
Accepted
This Committee first looked at post-pandemic backlogs in December 2021, publishing our report in March 2022. We noted that officials appeared to be planning on the basis of optimistic future scenarios and also that there was general over-optimism from officials on the short- and medium-term resilience of the NHS.15 The …
Government response. The government agrees to revisit planning assumptions and publicly report any updates to targets for cancer backlog, elective care waits, and the 18-week standard, with a target implementation date of Spring 2024, and states actions have been stepped up to …
HM Treasury
9
Recommendation
Thirty-Eighth Report - Managing NHS bac…
Accepted
We asked NHSE about its optimism at the time it agreed the recovery targets. It told us that its assumption about low levels of COVID-19 had turned out to be “completely wrong”. It added that this had resulted in both a higher than anticipated demand for hospital beds for patients …
Government response. The government agrees to revisit planning assumptions and publicly report any updates to targets for cancer backlog, elective care waits, and the 18-week standard, with a target implementation date of Spring 2024, and states actions have been stepped up to …
HM Treasury
10
Conclusion
Thirty-Eighth Report - Managing NHS bac…
Acknowledged
We shared our concerns about the risks facing the NHS and its ability to deliver the recovery targets and we pressed NHSE on how confident it was that it would meet the target to increase elective activity to 129% of 2019–20 levels by 2024–25.20 In some ways, this is the …
Government response. The Department and NHS England have stepped up actions to tackle the backlog and the ambitions in the Delivery Plan were agreed between NHS England and the government, based on detailed modelling and available funding at the time.
HM Treasury
11
Conclusion
Thirty-Eighth Report - Managing NHS bac…
Acknowledged
Macmillan Cancer Support and Healthwatch Suffolk submitted evidence to us containing powerful examples of the uncertainty, anxiety and other problems long waits cause patients. Macmillan Cancer Support told us that the impact of cancer care backlogs was being felt by people at all stages of the cancer pathway and that …
Government response. The government states that the department and NHS England have stepped up actions to tackle the backlog since the publication of the Delivery Plan for tackling the COVID-19 backlog of elective care.
HM Treasury
12
Conclusion
Thirty-Eighth Report - Managing NHS bac…
Acknowledged
The Department has allocated £14 billion to NHS England from 2022–23 to 2024–25 specifically to recover elective and cancer care, comprising £8 billion of resource funding and £5.9 billion of capital funding, as described in the November 2021 Budget and Spending Review.24 The Autumn Statement in November 2022 then, separately, …
Government response. The government announced an additional £3.3 billion for each of 2023-24 and 2024-25 and at the 2021 Spending Review, £14 billion was made available to the NHS to support Elective Recovery and NHS England will write to the Committee before …
HM Treasury
13
Conclusion
Thirty-Eighth Report - Managing NHS bac…
Acknowledged
We asked NHSE about whether, in its view, this would provide the NHS with sufficient funding, given its previous comments about the scale of the negative impact inflation had had on its budgets.26 The Chief Executive told us that it should be enough to deliver key priorities, including elective and …
Government response. The government announced an additional £3.3billion for each of 2023-24 and 2024-25 to support the NHS in England. NHS England will write to the Committee before summer recess to set out further detail on how funding available for elective recovery …
HM Treasury
14
Conclusion
Thirty-Eighth Report - Managing NHS bac…
Acknowledged
NHSE has estimated that the NHS was around 16% less productive in 2021 than before the pandemic.29 NHSE’s internal analysis indicated that this drop in productivity was not solely due to immediate pandemic pressures, but also resulted from staff being less likely to work paid or unpaid overtime, and a …
Government response. The government outlines actions to increase activity, manage demand and increase productivity, stating that NHS England monitors progress and has published planning guidance.
HM Treasury
15
Conclusion
Thirty-Eighth Report - Managing NHS bac…
Acknowledged
NHSE’s elective recovery programme includes plans for: • GPs to handle many elective cases previously dealt with by hospital doctors. Instead of referring some patients for elective care, GPs manage them within the 24 C&AG’s Report, paras 7, 1.15; Autumn Budget and Spending Review 2021, para 2.11 25 Autumn Statement …
Government response. The government highlights actions in the NHS published Delivery Plan are targeted at increasing activity, managing demand or increasing productivity and NHS England carefully monitors progress against delivery targets at regular intervals.
HM Treasury
16
Conclusion
Thirty-Eighth Report - Managing NHS bac…
Acknowledged
We asked how confident NHSE was about the component programmes in its plan, particularly those aimed at increasing elective and diagnostic capacity. It told us that it did not have strong evidence for some of its programmes at present, but said it was building evaluation into its programmes on surgical …
Government response. The government outlines actions to increase activity, manage demand and increase productivity, stating that NHS England monitors progress and has published planning guidance; NHS England will write to the Committee before summer recess to set out further detail of the …
HM Treasury
17
Conclusion
Thirty-Eighth Report - Managing NHS bac…
Acknowledged
Surgical hubs and community diagnostic centres have potential, but success will rely on them being adequately staffed. NHSE currently has limited evidence on hubs’ and CDC’s ability to continue operating when the wider NHS is under significant pressure.36 The Royal College of Surgeons also acknowledged the value of a thorough …
Government response. The government outlines actions to increase activity, manage demand and increase productivity, stating that NHS England monitors progress and has published planning guidance; NHS England will write to the Committee before summer recess to set out further detail of the …
HM Treasury
18
Conclusion
Thirty-Eighth Report - Managing NHS bac…
Acknowledged
We also asked NHSE whether its increased use of the independent healthcare sector might detract from or reduce activity within the NHS itself. NHSE told us that this was a key consideration in decisions about when to use the independent sector. It confirmed that it was working to support NHS …
Government response. The government outlines actions to increase activity, manage demand and increase productivity, stating that NHS England monitors progress and has published planning guidance; NHS England will write to the Committee before summer recess to set out further detail of the …
HM Treasury
19
Recommendation
Thirty-Eighth Report - Managing NHS bac…
Accepted
We asked NHSE about its programme management of the recovery and its strategic approach to tackling variation in performance between NHS areas. The National Audit Office found that, whilst recovery funding was allocated in September 2021 and the recovery plan published in February 2022, NHSE had only filled seven out …
Government response. The government agrees with the recommendation and will assess all providers based on their confidence in delivering against targets, with providers at highest risk receiving additional national support and oversight; implementation by July 2023.
HM Treasury
20
Conclusion
Thirty-Eighth Report - Managing NHS bac…
Acknowledged
NHSE told us that it monitored performance constantly, with fresh data available weekly, and that it was continually developing the metrics it uses to track performance. It argued that this was a comprehensive and agile approach.40 We heard how NHSE uses data to place NHS providers into tiers, depending on …
Government response. The government agrees and outlines actions taken, including provider assessments, additional support for high-risk providers, monitoring, and addressing health inequalities, with ICBs expected to develop delivery plans.
HM Treasury
21
Conclusion
Thirty-Eighth Report - Managing NHS bac…
Acknowledged
In response to our question about improving areas that have seen long-term underperformance, sometimes dating back to before the pandemic, NHSE told us that it had sent teams into some areas to support and challenge them.42 The National Audit Office report showed that the proportion of waiting patients who are …
Government response. The government agrees and outlines actions taken, including provider assessments, additional support for high-risk providers, monitoring, and addressing health inequalities, with ICBs expected to develop delivery plans.
HM Treasury
22
Conclusion
Thirty-Eighth Report - Managing NHS bac…
Rejected
This report is the Committee’s second on NHS backlogs, the first being published in March 2022. We stated then that “the NHS will be less able to deal with backlogs if it does not address longstanding workforce issues”.44 For this inquiry we received evidence from five medical Royal Colleges. The …
Government response. The government disagrees with the Committee’s recommendation, but states all aspects of NHS performance, and their impact for delivery, are kept under continued review by the department and NHS England.
HM Treasury
23
Conclusion
Thirty-Eighth Report - Managing NHS bac…
Rejected
We asked the Department if it agreed that it was more sustainable to train more doctors, nurses and other health professionals domestically, rather than be over-reliant on international recruitment. It told us that this question would be part of the review that will lead to the workforce plan it will …
Government response. The government disagrees with the Committee’s recommendation, but states all aspects of NHS performance, and their impact for delivery, are kept under continued review by the department and NHS England.
HM Treasury
24
Conclusion
Thirty-Eighth Report - Managing NHS bac…
Not Addressed
We asked about other key enablers of a successful recovery of elective and cancer care. NHSE told us about the particular negative impact of delayed discharges into adult social care, which had reduced its effective inpatient capacity.48 The Department confirmed that the additional funding for adult social care announced in …
Government response. The government disagrees with the Committee’s recommendation.
HM Treasury