Recommendations & Conclusions
31 items
2
Conclusion
Seventy-Third Report - Access to urgent…
Accepted
NHS England’s improvement plans rely on better staff recruitment and retention to address significant shortfalls in the NHS workforce, but we are not convinced that NHS England’s current approach will achieve its very optimistic assumptions. NHS England has identified a potential shortfall of 260,000 to 360,000 staff by 2036–37, compared …
Government response. The government agrees with the recommendation, highlighting the positive impact of the Exemplar programme on staff retention and outlining the NHS Long Term Workforce Plan's projections to reduce leaver rates. NHS England will also submit its full cost estimates for …
HM Treasury
3
Conclusion
Seventy-Third Report - Access to urgent…
Accepted
The quality of patients’ access to urgent and emergency care depends too much on where they live, particularly with wide variation in ambulance response times. There is significant regional variation in the performance of services for urgent and emergency care. For example, in 2021–22, average ambulance response times for the …
Government response. The government agrees and describes initiatives under the UEC recovery plan to standardise processes, increase referrals, and provide targeted support to challenged systems to reduce performance variation. NHS England commits to writing to the Committee in February 2024 to detail …
HM Treasury
4
Recommendation
Seventy-Third Report - Access to urgent…
Accepted
Not enough is being done to tackle delayed discharges, which cause inefficiencies both within hospitals and more widely across the care system. Delays with discharging patients when they are medically fit for discharge reduces available bed capacity, which in turn slows admissions from A&E departments, which in turn slows the …
Government response. The government agrees and states the recommendation is implemented, detailing an investment of an additional £1.6 billion by 2025 and outlining a wide programme of measures from the Urgent and Emergency Care recovery plan to tackle delayed discharges, including new …
HM Treasury
5
Conclusion
Seventy-Third Report - Access to urgent…
Rejected
Given long-standing declines in performance, we are not convinced the Department has sufficiently held NHS England to account for meeting targets and improving urgent and emergency care. The Department holds the NHS to account for performance in urgent and emergency care. It told us it works closely with NHS England …
Government response. The government disagrees with the recommendation, explaining that Parliament has already articulated the roles of the Department and NHS England. It asserts that the Department maintains effective oversight through mandates, annual assessments, regular ministerial meetings, and Prime Minister-led stocktakes, underpinned …
HM Treasury
6
Conclusion
Seventy-Third Report - Access to urgent…
Rejected
The unfunded and uncosted NHS Long Term Workforce Plan risks building in unsustainable financial pressures. The NHS Long Term Workforce Plan drawn up by NHS England only includes a commitment of an additional £2.4 billion to cover training costs for the first five years of the 15-year plan. The plan …
Government response. The government disagrees with the recommendation to provide a full 15-year cost update to the Committee, stating that NHS England will submit its estimates for the full cost of the NHS from 2025-26 onwards to the government as part of …
HM Treasury
1
Conclusion
Seventy-Third Report - Access to urgent…
Accepted
On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health & Social Care (the Department) and NHS England about access to unplanned or urgent care.1
Government response. The government agrees and outlines a comprehensive plan to improve patient flow and urgent care, including boosting bed capacity, implementing digital tools, increasing paramedic numbers, and introducing care transfer hubs and discharge funding through the Urgent and Emergency Care recovery …
HM Treasury
7
Conclusion
Seventy-Third Report - Access to urgent…
Accepted
The pandemic has also had an impact on NHS staff absence rates. NHS England pointed to mental health conditions and anxiety, musculoskeletal conditions and respiratory conditions that were affecting NHS staff.14 We asked whether NHS England has a percentage measure to assess how far staff sickness impacts on NHS productivity, …
Government response. The government agrees with the committee's finding, stating that the NHS is making progress in recovering lost productivity and reducing staff absences through ongoing efforts, the Long Term Workforce Plan, and incentive schemes, with a target implementation date of April …
HM Treasury
8
Conclusion
Seventy-Third Report - Access to urgent…
Acknowledged
A key element of NHS England’s plans for the NHS over the coming years is the NHS Long-Term Workforce Plan, published on 30 June 2023.16 Despite the decline in productivity in recent years, NHS England’s projections for future staff requirements in its workforce plan assume that NHS labour productivity will …
Government response. The government agrees (with what appears to be a conclusion) and states that improving productivity, including reducing staff absences and improving processes, is a key component of existing recovery plans. NHS England will provide further details on factors impacting productivity …
HM Treasury
9
Conclusion
Seventy-Third Report - Access to urgent…
Accepted
The Department told us that when looking internationally, demand for health across OECD countries goes up around 4% a year and improving productivity had to be one of the ways of meeting that demand. Alongside an increase in productivity, increasing the supply of services, improvements to public health in order …
Government response. The government agrees and is implementing digital tools like electronic bed management systems and System Control Centres, aiming to improve patient flow and productivity with a target implementation date of April 2024. They are also boosting capacity with 5,000 extra …
HM Treasury
10
Conclusion
Seventy-Third Report - Access to urgent…
Rejected
We raised concerns over the effectiveness of the Department’s oversight of NHS England’s performance against its targets, including the A&E target for 95% of patients to be admitted, transferred, or discharged within four hours.23 This target has not been achieved in the eight years since July 2015. In March 2023, …
Government response. The government disagrees with the Committee's concern over the effectiveness of its oversight of NHS England's performance, asserting it maintains close oversight through various mechanisms, including mandates and regular high-level meetings.
HM Treasury
11
Conclusion
Seventy-Third Report - Access to urgent…
Rejected
The Department recognised that there is an element of accountability in its relationship with the NHS, and said it was holding NHS England to account through the trajectories set out in numerous recovery plans, from primary care to elective recovery. The Department believed that the NHS was on trajectory to …
Government response. The government disagrees with the Committee's implicit concern regarding its oversight of NHS England's performance, stating it maintains effective oversight through mandates, regular ministerial meetings, and stocktakes.
HM Treasury
12
Conclusion
Seventy-Third Report - Access to urgent…
Rejected
The Department acknowledged that there were different sides of its approach to holding the NHS to account. It recognised that if there was a problem arising in a local authority it may fall to the Department to address, whereas problems in local trusts would be the responsibility of NHS England.29 …
Government response. The government explicitly disagrees with the committee's finding/implied recommendation regarding NHS management levels and accountability, defending the existing structure as articulated by Parliament and detailing its effective oversight mechanisms and performance monitoring.
HM Treasury
13
Conclusion
Seventy-Third Report - Access to urgent…
The Department told us that when compared internationally, the NHS had one of the lowest percentage spends on management compared to clinical roles, making it an efficient organisation when benchmarked. NHS England highlighted the example of a clinical leadership model in one trust led by a clinical member with a …
HM Treasury
14
Conclusion
Seventy-Third Report - Access to urgent…
Accepted
We and past Committees have repeatedly expressed concerns about variations in patients’ experience of health and care.32 The C&AG’s report highlighted considerable differences in both service performance and access across geographical areas and providers. Proportions of the most serious A&E patients waiting less than four hours in March 2023 ranged …
Government response. The government agrees with the committee's finding and states NHS England is actively working on improving and standardising UEC processes, providing targeted support to challenged systems. NHS England will write to the Committee in February 2024 to detail the underlying …
HM Treasury
15
Conclusion
Seventy-Third Report - Access to urgent…
Accepted
In 2021–22, mean Category 1 ambulance response times varied from six minutes 51 seconds for the London ambulance service to ten minutes 20 seconds for the South-West ambulance service, and average 999 call response times ranged from 5.4 seconds for the West Midlands ambulance service to 67.4 seconds for the …
Government response. The government agrees with the committee's finding, stating NHS England is working to tackle unwarranted variation in ambulance performance through the UEC recovery plan, providing targeted support to challenged systems, and will provide an update in February 2024.
HM Treasury
16
Recommendation
Seventy-Third Report - Access to urgent…
Accepted
There are differences in the capability of individual trusts, including around management, clinical leadership, and technology, that must be addressed to reduce variations in patients’ access to and experience of services.38 We asked witnesses how the worst performing trusts were being brought up to the standards of the best.39 The …
Government response. The government accepts the recommendation and states NHS England is actively working to reduce unwarranted variation in trust performance, focusing on the most challenged systems by providing maximum support, national experts, and improvement teams, with a target implementation date of …
HM Treasury
17
Conclusion
Seventy-Third Report - Access to urgent…
Accepted
NHS England described several different initiatives that it had piloted to improve services, for example around electronic patient records and workforce flexibility measures.41 It also informed us that it had recently launched a new programme of work 32 Committee of Public Accounts, NHS ambulance services, Sixty-second report of Session 2016–17, …
Government response. The government agrees with the committee's observation, stating that NHS England is actively working to tackle unwarranted variation in performance through the UEC recovery plan. They commit to writing to the Committee in February 2024 to detail the underlying causes …
HM Treasury
18
Conclusion
Seventy-Third Report - Access to urgent…
Accepted
The different services for urgent and emergency care are highly connected and interdependent, meaning that issues in one service impacts throughout the rest of the system.46 If the NHS is unable to discharge patients from hospitals when they no longer need to be there it means that people waiting in …
Government response. The government agrees with the observation and outlines an additional £1.6 billion investment over 2023-25 for care services and measures within the Urgent and Emergency Care recovery plan aimed at tackling delayed discharges and improving patient flow.
HM Treasury
19
Conclusion
Seventy-Third Report - Access to urgent…
Accepted
The number of patients staying in hospital despite no longer needing to be there averaged 13,623 across Q4 of 2022–23, an increase of 1,505 or 12% compared with 12,118 during the same period in 2021–22.49 We asked NHS England why delayed discharges had increased, and it told us this was …
Government response. The government agrees with the observation and details an additional £1.6 billion investment over 2023-25 to commission care services, alongside measures in the Urgent and Emergency Care recovery plan to tackle delayed discharges.
HM Treasury
20
Conclusion
Seventy-Third Report - Access to urgent…
Accepted
NHS England told us that the reasons why patients might experience delays in leaving hospital could be divided into four categories. For one group of patients, accounting for around 20%, the delays are related directly to activity in the discharging hospital.51 NHS England told us it was largely the responsibility …
Government response. The government agrees with the committee's finding and states the recommendation is implemented, citing an additional £1.6 billion investment and a comprehensive programme of measures from the Urgent and Emergency Care recovery plan to tackle delayed discharges, improve processes, and …
HM Treasury
21
Conclusion
Seventy-Third Report - Access to urgent…
Accepted
We have previously noted that the fragility of the adult social care provider market was exacerbating the difficulties in discharging older patients from hospital.55 NHS England agreed that there is a clear challenge in social care. Different solutions are needed in different parts of the country, but health and social …
Government response. The government agrees with the committee's findings, stating the recommendation has been implemented through an additional £1.6 billion investment and the Urgent and Emergency Care recovery plan, which funds services for rehabilitation, improves discharge processes, and increases adult social care …
HM Treasury
22
Conclusion
Seventy-Third Report - Access to urgent…
Accepted
NHS England told us it had instructed the NHS to speed up discharge processes, for example by minimising waits for supporting services such as transport and medications. It was also asking hospitals to monitor patients more closely to assess whether they needed to remain in hospital. We asked whether this …
Government response. The government agrees with the committee's finding, stating the recommendation has been implemented through an additional £1.6 billion investment and a comprehensive Urgent and Emergency Care recovery plan to tackle delayed discharges, improve processes, and increase social care capacity.
HM Treasury
23
Conclusion
Seventy-Third Report - Access to urgent…
Acknowledged
We have been raising concerns about the lack of long-term planning for the NHS workforce since well before the COVID-19 pandemic, noting in February 2023 that the Department had repeatedly failed to make good on its commitments to publish a plan to address the issue and that that many areas …
Government response. The government agrees with the committee's findings regarding workforce planning, confirming that NHS England's Long Term Workforce Plan, including a revised retention programme, is in motion to address challenges and reduce staff attrition rates by 2037.
HM Treasury
24
Conclusion
Seventy-Third Report - Access to urgent…
Acknowledged
In the workforce plan, NHS England estimates that over a 15-year period, without action, there would be a shortfall of 260,000 to 360,000 staff by 2036–37. NHS England explained that, because it takes time to train people and that they would be completing training over the course of the 15 …
Government response. The government agrees with the committee's findings, noting NHS England has revised its retention programme and the Exemplar programme shows improved leaver rates, with the Long Term Workforce Plan aiming to significantly reduce overall staff attrition by 2037.
HM Treasury
25
Conclusion
Seventy-Third Report - Access to urgent…
Acknowledged
NHS England added that, in terms of the specific offers that it would be making, the two most significant elements were measures focused on flexibility and continuous career development.67 It informed us that much of the retention aspects of the plan was about doing what works, doing this systematically, and …
Government response. The government agrees with the committee's findings, stating NHS England has revised its retention programme and the Exemplar programme shows improved leaver rates, with the Long Term Workforce Plan aiming to significantly reduce overall staff attrition by 2037.
HM Treasury
26
Conclusion
Seventy-Third Report - Access to urgent…
Acknowledged
We asked about the ongoing impact of the COVID-19 pandemic, since absence rates in the NHS workforce have remained higher since the start of the pandemic than the 61 Committee of Public Accounts, Sustainability and transformation in the NHS, Twenty-Ninth report of Session 2017–19, HC 793, 27 March 2018; Committee …
Government response. The government agrees with the committee's observations, noting the NHS is making progress in recovering lost productivity and reducing staff absences, with the Long Term Workforce Plan improving processes, and NHS England will provide further details on productivity factors and …
HM Treasury
27
Conclusion
Seventy-Third Report - Access to urgent…
The Department informed us that the government has not set out an equivalent long-term plan for the social care workforce, because they are mainly private employees of independent companies.78 It told us, however, that there are steps it had been taking. The Department ran a national recruitment campaign during 2022–23 …
HM Treasury
28
Conclusion
Seventy-Third Report - Access to urgent…
Rejected
We pressed both the Department and NHS England on how the workforce plan would be paid for.80 NHS England stated that the current government’s commitment has been to fully fund the first five years of the plan.81 In future periods, there would be decisions for the then government to take …
Government response. The government explicitly disagrees with the committee's finding/implied recommendation regarding the long-term funding of the workforce plan, reiterating its £2.4 billion commitment for the first five years and stating future funding estimates will be part of the next Spending Review.
HM Treasury
29
Conclusion
Seventy-Third Report - Access to urgent…
Rejected
The Department and NHS England told us that government had made a firm commitment of £2.4 billion of new money to fully fund the first five years of additional training places set out in the plan, until 2028.84 A planned expansion of medical school places up to 15,000 would be …
Government response. The government explicitly disagrees with the committee's finding/implied recommendation, reaffirming its £2.4 billion commitment to fund the first five years of the NHS Long Term Workforce Plan and stating that estimates for subsequent years will be submitted as part of …
HM Treasury
30
Conclusion
Seventy-Third Report - Access to urgent…
Rejected
NHS England confirmed that there is no specific funding for staff retention but said that it would be cost neutral. However, there are dependencies on several other factors that are important for retention. Staff wellbeing was outside the purview of the workforce plan and other measures, such as pension changes, …
Government response. The government explicitly disagrees with the committee's finding/implied recommendation regarding staff retention funding, highlighting its £2.4 billion commitment for training and deferring future funding estimates to the next Spending Review.
HM Treasury
31
Conclusion
Seventy-Third Report - Access to urgent…
Rejected
The Department emphasised the most important aspect of the plan was continued and sustained investment and that, particularly when thinking about technology and digitisation, it should be seen as a multiyear set of changes.88 NHS England added that there was a commitment and request from Treasury to refresh the plan …
Government response. The government explicitly disagrees with the committee's finding or implied recommendation, stating it has committed £2.4 billion for the NHS Long Term Workforce Plan and will address future funding needs as part of the next Spending Review process.
HM Treasury