Recommendations & Conclusions
8 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 …
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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 short- and medium- term, particularly as NHS staff have been working under continuously high pressure during the pandemic”. The recovery plan, however, continued this over- optimism by including assumptions about low levels of COVID-19 and minimal winter pressures, and that activity levels would recover to pre-pandemic levels early in 2022–23. Between April and August 2022, elective activity was at just 95% of pre-pandemic levels. The reality has been that the NHS continues to manage other major pressures, including ongoing effects of COVID-19, access to primary care, the performance of urgent and emergency care, workforce gaps, and problems with the supply of adult social care. NHSE told us that it would need to “reprofile” the trajectory of the recovery if it was to reach 129% during 2024–25. Macmillan Cancer Support and Healthwatch Suffolk submitted evidence to us with powerful examples of the uncertainty, anxiety and other problems experienced by long-waiting patients. Recommendation: NHS England and the Department of Health and Social Care should 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 wait target for elective care, and, ultimately, the 18-week legal standard for elective care.
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Government response AI summary
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 wait target for elective care, …
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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 …
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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 resource funding and £5.9 billion of capital funding. The Autumn Statement 2022 committed an additional £3.3 billion in 2023–24 and 2024–25 to the NHS budget as a whole. NHSE told us this would be sufficient for the NHS to deliver its key priorities. However, NHSE 6 Managing NHS backlogs and waiting times in England has opted not to produce a detailed costed version of its recovery plan to show how it expects all of the £14 billion to be spent. Without timely evaluation of its programmes, including surgical hubs and clinical diagnostic centres, there is a risk that the future allocation of resources will not be informed by reality on the ground. Overall, the NHS has a problem with reduced productivity. An internal review by NHS England estimated that the NHS was around 16% less productive in 2021 than in 2019 and said that the immediate effects of the pandemic were not the only cause. Recommendation: NHSE should transparently describe how the additional funds for elective recovery have been allocated. Alongside the Treasury Minute response, it should also write to us providing details of the programmes on which it expects the £14 billion to be spent, the independent evaluations it has put in place to monitor the effectiveness of additional spending, and how it expects additional spending to improve NHS productivity.
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Government response AI summary
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.
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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 …
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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 other parts of the health and social care system, and how they will work on a greatly expanded scale. NHSE told us it would ensure that capacity in surgical hubs, community diagnostic centres and the independent sector would be genuinely additional. However, it has more work to do to demonstrate how additional capacity will be sufficiently staffed without detracting from other NHS services. It is also concerning that NHSE could not provide the National Audit Office with its full evaluation of the 2021 elective accelerators programme, on which it spent £160 million. Recommendation: NHS England should know more about the conditions necessary for individual programmes to make the greatest contribution possible to recovery. Alongside its Treasury Minute response to this report, it should write to us more fully describing the real-world impact of community diagnostic centres, surgical hubs, increased use of the independent sector, and the advice and guidance programme. It should set out its understanding of the extent to which these initiatives have so far generated genuinely additional activity, rather than simply displacing activity elsewhere in the NHS.
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Government response AI summary
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.
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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 …
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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 March 2022 report on NHS backlogs, we stated that “the NHS will be less able to deal with backlogs if it does not address longstanding workforce issues”. Deferring action on this means not making the best use of the NHS’s existing hardworking and committed frontline staff. It is also clear that the success of the recovery programme is reliant on realistic long-term planning in other areas of health and care, including the capacity of adult social care where this is reducing flow through hospitals. The Department confirmed some of the steps it will take immediately, including to publish an independently verified forecast of the number of health professionals the NHS requires during 2023 and to allocate additional funds to improve hospital discharge into adult social care. These are not end-points, however, and results of this work must be incorporated into realistic planning assumptions for NHS elective and cancer recovery. Recommendations: • The Department of Health and Social Care should work with NHS England to reassess the achievability of elective and cancer recovery targets following the publication of its workforce plan in 2023, and planned improvements to the discharge of patients into adult social care. It should write to us as soon as possible describing the conclusions of this achievability assessment. • The Department should publish the underlying assumptions of its workforce projections alongside the forecasts in the workforce plan. This should include quantification of key assumptions, particularly on productivity, domestic training and overseas recruitment and, in full, the independent reviewer’s ass
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Government response AI summary
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 to publish the underlying assumptions …
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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 …
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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 NHSE hoped for. In our session NHSE had to acknowledge that it no longer expected to meet the target by March 2023.14 Over-optimism in recovery assumptions
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Government response AI summary
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 £3.3 billion for the NHS.
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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 …
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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 latest National Audit Office report states that the recovery plan contained over-optimistic assumptions about maintaining low levels of COVID-19 in 2022–23 and suffering minimal adverse effects from winter pressures.16 It notes that NHSE’s internal target for completed elective pathways in 2022–23 was 102% of the pre-pandemic level, but actually elective activity was at just 95% of pre-pandemic levels in the first five months of 2022–23.17 Put simply, this means that the elective recovery is already off track.
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Government response AI summary
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 tackle the backlog.
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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 …
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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 with COVID-19 and higher staff sickness absence.18 The National Audit Office report states that the NHS is also managing other major pressures, 7 C&AG’s Report, paras 16, 3.12, 3.13, Figure 11, Figure 12 8 C&AG’s Report, paras 16, 1.8, 3.12, 3.13. 9 Quarterly data available at: https://www.england.nhs.uk/statistics/wp-content/uploads/sites/2/2022/12/Cancer- Waiting-Times-National-Time-Series-Oct-2009-Oct-2022-with-Revisions.xlsx 10 C&AG’s Report, Figure 5. 11 Q 44 12 C&AG’s Report, para 16, 2.14 13 Available at: https://www.england.nhs.uk/wp-content/uploads/2022/07/B1881_Next-steps-in-the-recovery-of- elective-services_July-2022.pdf 14 Q 44 15 Committee of Public Accounts, NHS backlogs and waiting times in England, Forty-Fourth Report of Session 2021–22, HC 747, 16 March 2022 16 C&AG’s Report, para 3.2 17 C&AG’s Report, paras 14, 3.3 18 Q 11 10 Managing NHS backlogs and waiting times in England including other ongoing effects of the COVID-19 pandemic, access to primary care, the performance of urgent and emergency care, workforce gaps, and problems with the supply of adult social care.19
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Government response AI summary
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 tackle the backlog.
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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 …
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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 of 21 posts in its central programme management office by the end of May 2022. It also reported that NHSE still did not have the capability to report fully on performance, according to the measures it had itself identified, in August 2022.39
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Government response AI summary
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.
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HM Treasury