Recommendations & Conclusions
29 items
2
Conclusion
55th Report - Reducing NHS waiting time…
Accepted
NHS England’s plans to transform outpatient services were not credible, even though it had already acknowledged that more efficient outpatient services would make a material difference to the waiting list. The outpatients transformation had aimed to free up capacity in outpatients services and NHS England had set a target to …
Government response. The government agreed and stated the recommendation is implemented, citing a published review of governance, integration of outpatient transformation work, and ambitious proposals in the Medium Term Planning framework to reduce unnecessary follow-ups and improve triage.
HM Treasury
3
Conclusion
55th Report - Reducing NHS waiting time…
Accepted
NHS England’s approach to transformational change was deeply flawed in both monitoring of progress and the delivery of intended outcomes. NHS England’s diagnostic transformation programme displayed positive features of programme management and achieved planned increases in numbers of diagnostic tests. The planned number of Community Care Centres were also delivered …
Government response. The government agrees and will merge the Diagnostic and Elective capital boards into a single Planned Care Capital Assurance Board from January 2026 to consolidate monitoring of outcomes, benefits, and policy aims. A NIHR evaluation of 2022-2025 Targeted Investment Fund …
HM Treasury
4
Recommendation
55th Report - Reducing NHS waiting time…
Accepted
We are not confident that the Department is being realistic about the immense effort needed to reduce NHS elective care waiting times, and see a significant risk that digital solutions are being treated as a ‘cure- all’ as the 10 Year Plan is being implemented. While NHS England and the …
Government response. The government agrees and states the 10 Year Health Plan is affordable, committing up to £10 billion for NHS technology and digital transformation by 2028-29, including an additional £300 million capital investment announced at Autumn Budget 2025. It also sets …
HM Treasury
5
Recommendation
55th Report - Reducing NHS waiting time…
Acknowledged
NHS England’s performance to date has not demonstrated that it can secure the clinical engagement that will be necessary to transform waiting lists. Clinical engagement has worked best when there been close working between national and local clinical leaders, and specific and expert support between peers. The diagnostic transformation programme …
Government response. The government agrees and states it is strengthening clinical engagement, referencing existing plans and recent engagement events with clinicians, but does not outline specific new actions it will take to secure engagement differently for the outpatients transformation programme.
HM Treasury
6
Conclusion
55th Report - Reducing NHS waiting time…
Acknowledged
We are concerned that the Department for Health and Social Care and NHS England are still announcing major reforms without either delivery plans or secured funding. We do not accept that it is prudent to make a major change, such as the structural changes that are being made to Integrated …
Government response. The government agrees, stating ICBs are designing new staffing structures within existing budgets and discussing strengthened Health and Wellbeing Boards' coordination with local authorities, but it does not confirm it will not announce unfunded commitments or provide the requested costs, …
HM Treasury
1
Conclusion
55th Report - Reducing NHS waiting time…
Accepted
On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department for Health and Social Care (the Department) and from NHS England (NHSE) regarding NHSE’s management of transformation programmes to reduce elective care waiting times.1
Government response. The government agrees with the committee's introductory statement and details actions already implemented or underway, such as publishing waiting list information disaggregated by demographic data since July 2025, expecting systems to analyze and mitigate inequalities, and implementing processes to manage …
HM Treasury
7
Conclusion
55th Report - Reducing NHS waiting time…
Deferred
We also received written submissions from a range of individuals and organisations including clinicians and academics, royal colleges representing medical disciplines, care providers, think tanks and charitable organisations. A full list of the written evidence we received is available on the inquiry page of the Committee’s website.11 Particular issues and …
Government response. The government's response is entirely off-topic, detailing actions related to illegal meat imports, thereby failing to address the Public Accounts Committee's concerns regarding NHS elective care waiting times.
HM Treasury
8
Conclusion
55th Report - Reducing NHS waiting time…
Deferred
NHSE’s 2022 recovery plan ambition was to eliminate waits of longer than a year for elective care by March 2025. Within this, NHSE aimed that no one would wait longer than two years by July 2022, that there would be no waits of over 18 months by April 2023, and …
Government response. The government's response is entirely off-topic, detailing actions related to animal vaccine availability, thereby failing to address the Public Accounts Committee's factual conclusions regarding NHS elective care recovery plan ambitions and missed statutory targets.
HM Treasury
9
Conclusion
55th Report - Reducing NHS waiting time…
Deferred
NHS England (NHSE) told us that the additional diagnostics capacity it had created had been quickly backfilled by growth in demand. Its progress on achieving the diagnostics recovery target remained stuck, with the number of patients waiting more than six weeks remaining fairly flat over the past twelve months at …
Government response. The government's response is entirely off-topic, detailing actions related to animal disease resilience and a Sanitary and Phytosanitary agreement with the EU, thereby failing to address the Public Accounts Committee's factual conclusions regarding NHS diagnostics capacity and targets.
HM Treasury
10
Conclusion
55th Report - Reducing NHS waiting time…
Accepted
We received written evidence that long waiting times can put patients at risk. Evidence from Dr Rob Findlay noted that if it is not known what is wrong with undiagnosed patients then some of them will unexpectedly turn out to have a clinically urgent condition such as cancer.17 The National …
Government response. The government outlines existing measures to manage risks associated with long waits, including publishing waiting list information broken down by demographics, examining waiting list information, implementing management interventions, validating waiting lists, introducing a tiering system, and implementing harm review processes.
HM Treasury
11
Conclusion
55th Report - Reducing NHS waiting time…
Accepted
In July 2025 NHSE started publishing new data alongside the existing monthly Referral to Treatment Waiting Times data that showed that people from deprived communities and minority backgrounds are more likely to be waiting longer than 18 weeks for care than other groups.19 NHSE told us that one of the …
Government response. The government outlines existing measures to tackle health disparities in access to and waiting time for elective care, including publishing waiting list information broken down by demographics, examining waiting list information, implementing management interventions, validating waiting lists, introducing a tiering …
HM Treasury
12
Conclusion
55th Report - Reducing NHS waiting time…
Accepted
NHSE has aimed to free up capacity in outpatient services to allow more patients from the waiting list to be seen. In 2022, NHSE set a target to reduce outpatient follow-up appointments by 25% compared with 2019–20 levels by March 2023. The outpatients programme spent £52 million from 2021–22 to …
Government response. DHSC and NHS England undertook a review of programme governance to ensure the right structures are in place to deliver the ERP, which was published in January 2025. The Medium Term Planning framework (2026-27 to 2028-29) has set out ambitious …
HM Treasury
13
Conclusion
55th Report - Reducing NHS waiting time…
Accepted
In 2022 our predecessor Committee was told by NHSE that the area where it has most potential to free up clinical time and see more patients is in outpatients services because “80% of the waiting list is tied 18 NIHR Policy Research Unit on the Economics of Health and Social …
Government response. The government states that DHSC and NHS England undertook a review of programme governance and integrated outpatient transformation work to improve performance and deliver the Elective Reform Plan. It also sets out aims for transforming outpatient care with single points …
HM Treasury
14
Conclusion
55th Report - Reducing NHS waiting time…
Accepted
NHSE told us that it had got very close to achieving large changes to outpatients services, but a long period of industrial action had disrupted appointments and that a new plan and better clinical engagement was required.26 NHSE told us that there should have been more of a focus on …
Government response. The government states that DHSC and NHS England undertook a review of programme governance and integrated outpatient transformation work to improve performance and deliver the Elective Reform Plan. It also sets out aims for transforming outpatient care with single points …
HM Treasury
15
Conclusion
55th Report - Reducing NHS waiting time…
Accepted
NHSE said that it had made progress in some areas, partly where necessity during the Covid 19 pandemic had driven the adoption of technology. NHSE highlighted the advice and guidance scheme, which allows GPs to request specialist input without going through a full referral. This scheme had seen continued growth …
Government response. The government acknowledges the importance of monitoring and evaluation of policy development and provides details of progress on A&G, investing in e-RS to support data collections and governance, with the aim of supporting tracking of costs and benefits of A&G …
HM Treasury
16
Conclusion
55th Report - Reducing NHS waiting time…
The Department wrote to us on 10 September 2025 to confirm that it has drawn down £2.2 billion of capital funding for diagnostic transformation and £1.04 billion for surgical hubs. It also confirmed that 122 surgical hubs were operational in England.32 The Department had previously written to tell us that …
HM Treasury
17
Conclusion
55th Report - Reducing NHS waiting time…
Accepted
The NAO report found that while CDCs are operational and have provided an increasing proportion of diagnostic activity, NHSE analysis in June 2024 showed that it would not meet waiting list targets due to a shortfall of around 3.6 million tests.34 We questioned the Department whether for CDCs there had …
Government response. Data collections and processes for tracking costs and benefits for the national diagnostics programme have been in place since 2021.
HM Treasury
18
Conclusion
55th Report - Reducing NHS waiting time…
NHSE told us that the additional diagnostic capacity it has created has been quickly taken up by growth in demand and that the NHS was also trying to control non-elective urgent demand.37 We were told however that while it was still struggling with waiting times, patient satisfaction rates are around …
HM Treasury
19
Conclusion
55th Report - Reducing NHS waiting time…
The NAO report found that the diagnostic programme has the most established governance structure and there was evidence of in-depth reporting, while governance was less developed for surgical transformation hubs.40 The Department told us that whilst it had previously had two teams and two boards providing separate governance arrangements, it …
HM Treasury
20
Conclusion
55th Report - Reducing NHS waiting time…
Accepted
The Department of Health and Social Care (the Department) told us that future plans for transformation will involve changing the way that care is delivered, including using digital technology in different ways.44 The Department said that in practice the transformation plans outlined in the 10 Year Plan will involve putting …
Government response. The government agrees and describes the ongoing shift to digital in elective care transformation, emphasising the need for organisational and cultural change, deploying interoperable Electronic Patient Records, strengthening cyber security, and ensuring transparent data governance.
HM Treasury
21
Conclusion
55th Report - Reducing NHS waiting time…
Accepted
NHSE told us that integration and record sharing across the NHS system features heavily within the 10 Year Health Plan, aiming to address a key weakness of the current system. NHSE said that digital transformation in the NHS presents unique challenges, compared to other healthcare systems, as there are no …
Government response. The government agrees and describes the ongoing shift to digital in elective care transformation, emphasising the need for organisational and cultural change, deploying interoperable Electronic Patient Records, strengthening cyber security, and ensuring transparent data governance.
HM Treasury
22
Conclusion
55th Report - Reducing NHS waiting time…
Accepted
Evidence submitted by the Royal College of Ophthalmologists and the Royal College of Radiologists noted that technology can be used to eliminate waste in the system and prioritise patients better. However, the Royal College of Physicians told us in their evidence that while technology presents opportunities, it had conducted a …
Government response. NHSE and DHSC will publish the most recent outcomes from the Digital Maturity Assessment (DMA) in the near future. They will be working to tackle the gaps identified through a range of programmes, to start delivery in April 2026. This …
HM Treasury
23
Conclusion
55th Report - Reducing NHS waiting time…
Accepted
NHS England (NHSE) engaged clinicians on the transformation programmes in various ways including working with representative bodies and embedding National Clinical Directors within the programmes to provide medical leadership. The surgical transformation programme benefited from in-person engagement and support from the Royal College of Surgeons of England.50 On the diagnostics …
Government response. The government agrees that securing clinical support is essential for successful outpatient transformation and is strengthening clinical engagement with the aim of delivering outpatient care remotely or in community settings by March 2026.
HM Treasury
24
Recommendation
55th Report - Reducing NHS waiting time…
Accepted
NHSE told us that it had struggled to get the clinical community uniformly behind the outpatients programme and that engagement had also been highly variable from specialty to specialty. We heard from the Department and NHSE that in their view the outpatients programme required extensive change to the way everyone …
Government response. The government agrees and commits to strengthening clinical engagement to ensure clinicians are delivery partners in transforming planned care, aiming to deliver outpatient care remotely or in community settings, with a target implementation date of March 2026.
HM Treasury
25
Recommendation
55th Report - Reducing NHS waiting time…
Accepted
NHSE accepted that any reform or change management programme cannot work without clinical engagement, and told us that it was now carrying out a range of activities to secure clinical support for the outpatients programme. NHSE explained that, among other measures, it was providing access to performance data at a …
Government response. DHSC and NHS England are strengthening clinical engagement and ensuring clinicians are delivery partners in transforming planned care. They will continue to use existing forums with Royal Colleges and Getting It Right First-Time specialty leads to test delivery, attend national …
HM Treasury
26
Conclusion
55th Report - Reducing NHS waiting time…
Accepted
On 13 March 2025, the Government announced that NHSE would be abolished within two years and that the Department would put in place arrangements to deliver the responsibilities currently delivered by NHSE.57 On the same day, as part of our evidence session on the 2023–24 Annual Report and Accounts of …
Government response. The government agrees with the committee's observation regarding the abolishment of NHSE and the cost-cutting measures for ICBs, aiming for implementation by Spring 2026 and bringing forward £860 million to support upfront costs.
HM Treasury
27
Conclusion
55th Report - Reducing NHS waiting time…
Accepted
At our March 2025 session, NHSE told us that it was having discussions with the Cabinet Office and HM Treasury and that changes of this scale would require a redundancy scheme. NHSE told us that ICBs employed approximately 25,000 further staff and that it expected reductions to achieve around £700 …
Government response. The government agrees with the committee's observation regarding discussions with the Cabinet Office and HM Treasury, and the expected savings from ICB staff reductions, aiming for implementation by Spring 2026 and bringing forward £860 million to support upfront costs.
HM Treasury
28
Conclusion
55th Report - Reducing NHS waiting time…
Accepted
In the September session, NHSE told us that the changes had been very dramatic and that a lot of work had been done very quickly to start to reduce the variation in running costs for ICBs as well as some of the key cost drivers.60 We were told that redundancies …
Government response. The department accepts the Committee’s recommendation and will deliver a modernised health system through the integration of NHS England into DHSC and the associated restructuring of Integrated Care Boards (ICBs). The government will publish proportionate assessments to support the scale …
HM Treasury
29
Recommendation
55th Report - Reducing NHS waiting time…
Accepted
Reports by this Committee and its predecessors have highlighted the risks to value for money raised by sudden policy changes that are not supported by sufficient funding and planning. In 2023, the Committee reported that the decisions made by the Department in planning the New Hospitals Programme could not be …
Government response. The government agrees with the Committee’s recommendation and is prioritising record investment in the health and social care system, such that all the reforms and commitments that have been announced are affordable within the Department of Health and Social Care’s …
HM Treasury