Recommendations & Conclusions
13 items
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 …
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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 in February
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Government response AI summary
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.
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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 AI summary
The government acknowledges the committee's conclusion regarding NHS backlogs and waiting times and states their commitment to reducing cancer waiting times.
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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 …
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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 most important target because increasing activity is what will enable all the other targets to be met. We noted the importance of reaching higher levels of activity as soon as possible so as to begin reducing the backlog of people waiting for elective care. NHSE told us that it continued to aim for 129% in 2024–25 but that it recognised it would need to “re-profile” its trajectories for getting there.21
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Government response AI summary
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.
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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 …
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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 people were worried about a reduced chance of surviving cancer because of the delays.22 On elective care, Healthwatch Suffolk told us of the wider, often long-term impacts that treatment delays can have, including people having to live with increased pain and experiencing detrimental effects on their mental health, social life, and wellbeing.23 19 C&AG’s Report, para 2 20 Q 13 21 Q 14 22 NHS0033 23 NHS0008 Managing NHS backlogs and waiting times in England 11 2 Ensuring effectiveness of recovery plans Additional spending
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Government response AI summary
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.
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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, …
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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, committed additional funding to the overall NHS budget due to financial pressures. NHSE’s planned resource limit for 2024–25 is now £166 billion: “£3.3 billion in each of the next 2 years to support the NHS in England in response to the significant financial pressures it faces, and [enable] rapid action to improve emergency, elective and primary care performance”.25
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Government response AI summary
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 summer recess to set out …
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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 …
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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 cancer recovery. NHSE also listed the continuing risks to recovery, many of which could reduce the value of this latest spending settlement: these include, in particular, risks relating to industrial action, and any increases in the assumed level of inflation.27 The National Audit Office report notes that NHSE has so far 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.28
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Government response AI summary
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 will be spent, together with …
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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 …
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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 reduced management focus by NHSE and NHS trusts on cost control and operational rigour.30 In responding to our questions about how it is practically addressing the productivity problem, NHSE said that the work had to begin at the level of individual providers. It told us that a provider should begin by working through available data to understand the specific issues it was facing, in order to come up with a plan to improve productivity. It indicated that it would be leading this kind of process throughout the country during the next annual planning round.31 New programmes and initiatives for recovery
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Government response AI summary
The government outlines actions to increase activity, manage demand and increase productivity, stating that NHS England monitors progress and has published planning guidance.
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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 …
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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 2022, para 5.57, table 2.1 26 NHS England Board Paper, 6 October 2022 27 Q 105 28 C&AG’s Report, paras 7, 1.23 29 C&AG’s Report, paras 13, 3.21 30 C&AG’s Report, para 3.21 31 Q 96 12 Managing NHS backlogs and waiting times in England primary care system after receiving advice and guidance from hospital doctors. The recovery plan aims for 1.7 million elective referrals to be avoided in this way in 2022–23, rising to 2.0 million in 2023–24. • Surgical hubs and community diagnostic centres which contribute to elective recovery by improving efficiency and access to services. These two programmes may provide resilience by allowing elective care to continue on physically separate ‘cold sites’ when other parts of hospitals struggle with high rates of bed occupancy or other kinds of patient demand.32
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Government response AI summary
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.
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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 …
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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 hubs and community diagnostic centres.33 It said “the basis of a formal evaluation is clearly in place”.34 We hope that NHSE will take this responsibility to evaluate seriously. These are promising programmes but they must prove themselves in practice. We were concerned that NHSE had been unable to find its evaluation of a previous programme, elective accelerators, which provided £160 million to 12 local systems in 2021. The systems were supposed to increase their elective activity but in practice activity still fell short of pre-pandemic levels.35
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Government response AI summary
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 impact of community diagnostic centres, …
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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 …
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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 evaluation of surgical hubs, stating that “whilst the underpinning theory for surgical hubs is sound, and there are examples of good practice, we recognise the need for more empirical evidence to confirm the extent to which surgical hubs can increase productivity, and also to consider their wider impacts”.37
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Government response AI summary
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 impact of community diagnostic centres, …
Read full response →
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 …
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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 and independent sector providers to work as productively as possible together.38 32 C&AG’s Report, para 8, 1.24 33 Q 61 34 Q 62 35 C&AG’s Report, para 1.25 36 C&AG’s Report, paras 8, 2.22, 2.29 37 NHS0021 38 Qq 67, 69 Managing NHS backlogs and waiting times in England 13 3 Improving planning Improving strategic and programme management
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Government response AI summary
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 impact of community diagnostic centres, …
Read full response →
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 …
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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 how on or off track they are against targets. It then seeks to provide greater support to those organisations that are more off track, including sharing best practice from other areas.41
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Government response AI summary
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.
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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 …
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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 in scope of the target to eliminate 78-week waits by April 2023 ranges from 2% to 20%, depending on the part of the country. This means that the challenge of meeting the target is vastly harder for some parts of the NHS than others.43 Key dependencies including workforce planning
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Government response AI summary
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.
Read full response →
HM Treasury