Select committee inquiry
NHS waiting times for elective and cancer care inquiry
Closed
What the inquiry looked at
“The Department of Health and Social Care (the Department) has a number of waiting times performance standards, which describe the percentage of patients that NHS bodies must treat within maximum waiting times: For elective treatment (the treatment of non-urgent conditions, covering general medicine, neurosurgery and orthopaedics), the aim is for 92% of patients to be seen by a consultant within 18 weeks after referral; For cancer assessment , the aim is for 93% of patients to be seen by a cancer specialist within 2 weeks of an urgent GP referral where cancer is suspected; and For cancer treatment , the aim is for 85% of patients to wait no longer than 62 days from urgent GP referral to first treatment. However, a recent National Audit Office (NAO) report has found that while the NHS has increased the number of people it treats each year, the percentage of patients treated within waiting time standards continues to decline for both elective and cancer treatment. The 92% target for elective care was last met nationally in February 2016 and the 85% target for cancer treatment has not been met since the end of 2013. The report identified that there is significant variation across England in terms of waiting times. In 2017-18, the number of patients waiting less than 18 weeks for their elective care varied between 75% and 96% across clinical commissioning groups (CCGs). For cancer treatment, the percentage of patients treated within 62 days ranged from 59% to 93%. There is also variation across specialities: performance for lung, lower gastrointestinal and urological cancers was significantly lower than other cancers. The number of referrals has increased, which has had a knock-on effect on waiting times. For instance, between 2010-11 and 2017-18, the number of patients referred urgently for suspected cancer increased by 94%. The NAO report found that, for cancer, this is due to NHS England’s policy of encouraging more urgent referrals to improve early cancer diagnosis; this has improved early diagnosis of cancer and improved survival rates. However, it also found that NHS England’s understanding of the increase in elective care referrals is limited. Nevertheless, the report found that constraints on capacity, including a lack of finance, staff and beds is linked with the decline in waiting time performance. On 24 April, the Public Accounts Committee will question the heads of the Department of Health and Social Care and NHS England on the action they are taking to address declining waiting time performance. In the context of rising demand and increasing constraints on capacity, the Committee will explore variation between different areas of the country, the impact of delays on patients and factors such as staff shortages and bed capacity.”
The committee's words, from the inquiry page on parliament.uk ↗.
What it found
In the committee's words, from the summary of 100th Report - NHS waiting times for elective and cancer treatment ↗
The NHS treats more and more people each year, and patients have a right to expect to receive treatment within the timescales set out by the NHS Constitution. But more and more patients are being let down by the NHS’s continued failure to meet deadlines for waiting times. The percentage of patients treated within waiting times standards continues to get worse for both elective (non-urgent care) and cancer treatment. It is unacceptable that less than half of NHS trusts and foundation trusts (trusts) meet the 18-week waiting times standard for elective treatment, and only 38% meet the 62-day standard from referral to treatment for cancer patients.
Like many areas within the NHS, demand for elective and cancer treatments is growing which risks exacerbating this worsening performance. The waiting list for elective care has grown by one and a half million since March 2013 to 4.2 million in November 2018.
NHS organisations are not being sufficiently held to account for ensuring patients’ rights to treatment within maximum waiting times for elective care. The NHS does not yet fully understand what is driving the demand for elective care, undermining its ability to plan services to meet patient needs. We are also concerned that the national bodies responsible for setting and managing waiting times appear to lack curiosity regarding the impact of longer waiting times on patient outcomes and on patient harm. Improvement is clearly needed to ensure patients get the treatment they need within the waiting times standards the government has set. The long-term term funding settlement for the NHS, the NHS Long Term Plan, and the current review of waiting times standards present an opportunity to get the NHS back on track in meeting waiting times standards.
What the government said
No government response is linked to this report.
How the inquiry ran
Each dot is a dated item listed on this page, from the inquiry's opening on 24 April 2019 to 12 June 2019.
- Oral evidence 24 Apr 2019
- Report 12 Jun 2019
- Correspondence 2 letters
What it recommended 1 recommendation · 24 conclusions
1The NHS is failing to meet key waiting times standards for cancer and elective care,...
Recommended (the committee's words)
The NHS is failing to meet key waiting times standards for cancer and elective care, and its performance continues to decline. The NHS is treating more people for suspected cancer and elective care than ever before. For example, the number of patients referred for elective care has increased by 17% since 2013–14 and the number of patients referred for suspected cancer has almost doubled since 2010–11. However, the NHS has not met the 18-week waiting times standard for elective care since February 2016. In November 2018, 44% of NHS trusts and NHS foundation trusts (trusts) met this standard. The waiting list for elective care has grown, from 2.7 million in March 2013 to 4.2 million in November 2018. The NHS has not met the 62-day standard from urgent referral for suspected cancer to treatment since 2013, and in November 2018 only 38% of trusts met this standard. In 2015, NHS England committed to us that it would improve performance against the 62-day cancer standard, but performance has further declined since. Between July and September 2018, only 78.6% of patients were treated within 62 days of an urgent referral, down from 83.8% between September and December 2014. Substantial improvement is clearly needed. NHS England and NHS Improvement assert that that they will be in a better position to determine how best to improve performance once local NHS organisations have published their forward plans in September 2019. Recommendation: NHS England should set out, by December 2019, how, and by when, it will ensure that waiting times standards for elective and cancer care will be delivered again.
2The Department of Health & Social Care has allowed NHS England to be selective about...
Concluded (the committee's words)
The Department of Health & Social Care has allowed NHS England to be selective about which standards it focuses on, reducing accountability. Under the NHS Constitution, patients in England have the right to be treated within maximum waiting times. It is important that Parliament and the public can rely on NHS waiting times standards to hold the NHS to account over patients’ rights to timely access to care. However, in response to rising demand while under increasing financial constraints, the Department has allowed NHS England to prioritise meeting standards for emergency services and cancer care over elective care. NHS England told us that, in recent years, it has removed sanctions and penalties against NHS trusts for failing to meet elective care waiting times standards, as many of the trusts were already in financial difficulties. We welcome the action taken by NHS England to focus on reducing the number of patients waiting 52 weeks and over for elective care, but we are concerned that the Department is no longer holding NHS England to account for the other service standards that are still in place. Recommendation: The Department of Health & Social Care and NHS England should clarify to the Committee by December 2019: • how NHS England will be held accountable for achieving waiting times standards now and in the future; and • what additional support NHS England and NHS Improvement will put in place to help local NHS bodies to meet waiting times standards. 6 NHS waiting times for elective and cancer treatment
3We are concerned that NHS England’s review of waiting times will not be enough to...
Concluded (the committee's words)
We are concerned that NHS England’s review of waiting times will not be enough to ensure a clear understanding of, and strong accountability over, the performance of the NHS. We welcome NHS England’s current review of standards for accessing NHS services, which includes waiting times standards for cancer and elective treatment. Its interim report, published in March 2019, proposes several changes to cancer and elective waiting times standards. Some stakeholders are concerned that, given the ongoing failure by the NHS to meet the 18-week standard, the review could be used as an opportunity to make the target easier to meet or less appropriate. The review is an opportunity to put patient experience and outcomes at the centre of waiting time standards, but the health bodies involved must ensure that strong accountability for performance remains if standards are being altered. It is also important that the NHS engages with the public regarding any changes that may affect their access rights. Recommendation: The Department of Health & Social Care should ensure that any changes to current waiting times standards: • help to improve patient outcomes and patient experiences; • do not water down current standards to make them easier to meet; and • are communicated clearly to the public, so that patients understand what they can expect of the NHS.
4The national health bodies lack curiosity about the impact for patients of longer waits and...
Concluded (the committee's words)
The national health bodies lack curiosity about the impact for patients of longer waits and how often this leads to patient harm. When waiting times are longer, patients may experience additional pain, anxiety and inconvenience. There is also a risk that longer waiting times may lead to patient harm through, for example, the deterioration of a medical condition. Similarly, outcomes for those who wait for more than six months for treatment can be poorer. The NHS has a very limited understanding of this issue. Although trusts collect data on patient harm through an incident reporting system, which is overseen by NHS Improvement, the data cannot be used easily to help understand the relationship between waiting times and patient harm. Individual trusts may carry out harm reviews due to long waiting times, but these data are not collected at a national level. NHS England is aware that some patients have suffered harm due to long waits and that research on the relationship between patient harm and waiting times is not consistent. NHS England relies on the professional judgement of clinicians to ensure that patients do not come to harm because of longer waiting times but accepts that widespread unwarranted variations in clinical practices exist across the country. Recommendation: The Department of Health & Social Care, together with NHS England and NHS Improvement, should write to us by December 2019 on how they are going to ensure that the data on patient harm due to long waiting times are going to be routinely collected, reported and acted upon.
5Bottlenecks in hospital capacity are having a detrimental impact on how long patients wait for...
Concluded (the committee's words)
Bottlenecks in hospital capacity are having a detrimental impact on how long patients wait for treatment. There are wide variations in performance against waiting times standards across local areas and hospitals. For example, the proportion of patients waiting less than 18 weeks for their elective care varied between 75% and 96% across CCGs in England in 2017–18. Poorer performance in waiting NHS waiting times for elective and cancer treatment 7 times is related to bottlenecks in hospital capacity, including diagnostics and bed occupancy. We have highlighted the persistent lack of capacity in diagnostics services, including shortages in diagnostics staff, in our previous reports. In terms of access to diagnostics, England compares poorly to other countries that have a similar level of income to England. Hospitals now routinely operate with a bed occupancy rate of more than 90%. This can affect elective patient care as patients may have their elective care treatment postponed because the beds are needed for emergency admissions, resulting in delays to treatment. We are concerned that the number of NHS beds has been reduced over recent years but the NHS does not know what the right level of beds is to meet the growing demand for its services. NHS Improvement told us that there is still room to make better use of existing beds through improving patient pathways which may help meet some of the demand for services. Recommendation: NHS England and NHS Improvement should evaluate and report back to the Committee on how the NHS plans to ensure that it has the required diagnostic and bed capacity to meet patient demand in the medium to long term. They should also set out, in the short term, how they will support local bodies to improve their patient flow through the health system and reduce unwarranted variation.
6The NHS still does not understand sufficiently what is driving demand for referrals for elective...
Concluded (the committee's words)
The NHS still does not understand sufficiently what is driving demand for referrals for elective treatment. Between the 12 months to March 2014 and the 12 months to November 2018, the number of referrals for elective treatment increased by 17%. Our recent report on NHS financial sustainability, published in March 2019, concluded that the rising demand for NHS services is not sufficiently well understood. The Department asserts that there are three groups of factors which are driving the increase in demand for elective treatment: demography, technology, and patient expectations. NHS Improvement explained that up to 45% of inpatient admissions and 25% of outpatient referrals are due to a growing and ageing population. But the impact of technology and patient expectations on referrals for elective treatment are difficult to quantify and less researched. NHS England expects local commissioners and sustainability and transformation partnerships (STPs) to forecast and develop plans to meet the demand from their local populations. However, we are concerned that each local body carrying out its own analysis will lead to duplication of efforts. Recommendation: As we recommended in March 2019, NHS England and NHS Improvement should, by September 2019, write to us to set out how they will help local bodies to better understand the demand for care, and to plan their services accordingly to better meet the needs of their local patients.
7NHS England has not yet identified how it will manage the variety of factors that...
Concluded (the committee's words)
NHS England has not yet identified how it will manage the variety of factors that could affect the success of its plans to better manage elective care. The NHS Long Term Plan, published in January 2019, commits to reducing face-to-face outpatient visits by one-third as part of a wider attempt to manage demand, but NHS England has not set out how this will be achieved. NHS England expects local STPs and integrated care systems to publish plans this autumn, setting out how this will be achieved for their local populations. We are concerned that it will be difficult for these local partnerships to plan effectively when they already face considerable uncertainties, for example, in their local budgets for capital, education and training, 8 NHS waiting times for elective and cancer treatment and adult social care. NHS England expects the next spending review to provide clarity on these budgets, but the timing of this is also uncertain. The NHS has not yet published its people plan to support its Long Term Plan. It often takes many years to train key staff such as those working in diagnostics, meaning staff shortages in these areas will continue for at least the next few years. Reducing outpatient appointments through providing more care in the community will also require an increase in capacity for primary care. NHS England told us that it will develop primary care networks that will cover a population of between 30,000 to 50,000 people, but we are concerned that this may not work well for rural areas. Recommendation: The Department, NHS Improvement and NHS England should, by December 2019, clarify to us: • How they are going to develop a fit-for-purpose workforce to ensure that the ambition to reduce face-to-face appointment by one-third is going to be achieved. • How they are going to ensure access to care is maintained if the number of outpatient appointments is not reduced as planned. NHS waiting times for elective and cancer treatment 9 1 Delivering NHS waiting times standards for elective and cancer treatment
8The Government introduced waiting times to help improve patients’ satisfaction with the NHS as well...
Concluded (the committee's words)
The Government introduced waiting times to help improve patients’ satisfaction with the NHS as well as patient outcomes. It is important that Parliament and the public can rely on waiting times standards to hold the NHS to account, to track progress made and, more importantly, to gain assurance over patients’ rights to timely access to care.9 The Department told us that it was very important to have waiting times standards to set out expectations for the public and NHS organisations, to track progress and to send the right signals to the system. NHS England added that it also allows for benchmarking between different countries.10 5 Qq 18, 19, 31, 32; C&AG’s Report, paras 9 and 12 6 Q6, C&AG’s Report, paras 8, 10 7 Qq 18–19; Committee of Public Accounts, Progress in improving cancer services and outcomes in England, Forty-fifth Report of Session 2014–15, 2 March 2015; Treasury Minutes, Government responses on the Thirtieth, the Thirty Fifth, the Thirty Seventh, and the Forty First to the Fifty Third reports from the Committee of Public Accounts Session 2014–15, Cm 9091, July 2015; NHS England, Cancer waiting times national time series – Provider based October 2009 to February 2019 Q4 2008–09 to Q3 2018–19 8 Qq 21–24, 31–35 9 Q 56; C&AG’s Report, para 1.2 10 Q 17 NHS waiting times for elective and cancer treatment 11
9The National Audit Office reported that, facing rising demand while under increasing financial constraints, national...
Concluded (the committee's words)
The National Audit Office reported that, facing rising demand while under increasing financial constraints, national bodies have focused more on emergency and cancer care than elective care.11 NHS England explained that this reflected the clinical priority of these conditions. The Department told us that it asks the NHS to simultaneously pursue a range of different targets, including heart disease, mental health and older people’s services and that the NHS must balance these different priorities when making choices about NHS care.12
10Since 2015, NHS England has gradually removed financial sanctions and penalties against NHS trusts for...
Concluded (the committee's words)
Since 2015, NHS England has gradually removed financial sanctions and penalties against NHS trusts for failing to meet elective care waiting times standards. NHS England’s and NHS Improvement’s planning guidance for 2018–19 no longer required trusts to meet to meet the 18-week target for elective care. We were concerned that this could imply to local health bodies that these targets are no longer important. NHS England told us that it had removed sanctions because many trusts were already in financial difficulties and additional sanctions would not add anything”13
11We asked whether the 18-week elective care target was a genuine target for the NHS...
Concluded (the committee's words)
We asked whether the 18-week elective care target was a genuine target for the NHS and whether witnesses were concerned that the target was not being met. NHS England and the Department asserted that short waits for routine care do matter to the NHS, but the recent action it described has focussed on those waiting over 52 weeks. The Department told us that it took ‘significant management action’ when it saw an increasing number of patients waiting 52 weeks and over in order to reverse this trend. NHS England told us that, “to send a clear signal” to people who wait 52 weeks, it was reinstating financial penalties for both providers and commissioners where patients wait longer that 52 weeks for treatment, but not for those waiting more than 18 weeks. NHS England assured us that it will ask CCGs to increase the amount elective care undertaken in the next five years, and that it was taking action to treat more people within short waiting time targets.14 Clinical review of waiting times standards
12NHS England is carrying out a review of NHS access standards which covers waiting times...
Concluded (the committee's words)
NHS England is carrying out a review of NHS access standards which covers waiting times standards for cancer and elective treatment. It published its interim report in March 2019 which proposed several changes to cancer and elective waiting times standards. The main proposed change to waiting times standards for cancer is the introduction of a 28- day standard from a patient’s referral to their diagnosis to replace the current two-week waiting time standard from a patient’s referral to their first appointment with a specialist. For elective care, the report proposed to explore a number of options, including an average waiting time target to replace the current 92% 18-week standard.15 We heard from the Independent Healthcare Providers Network and Versus Arthritis that they were concerned that, given the ongoing failure by the NHS to meet the 18-week standard, the review could be used as an opportunity to make the target easier to meet or less appropriate.16 11 C&AG’s Report, paras 14,17 12 Q 13 13 Qq 10–11, 16–17, C&AG’s Report, Figure 7 14 Qq 9–11, 13; C&AG’s Report, para 17 15 Qq 3, 36, 37, 56, 57; Versus Arthritis (ECC0004), para 45; Clinically-led Review of NHS Access Standards: Interim Report from the NHS National Medical Director, March 2019 16 Qq 36–46, 56, 57, 94, 95; Independent Healthcare Providers Network (ECC0001); Versus Arthritis (ECC0004) 12 NHS waiting times for elective and cancer treatment
13NHS England and stakeholders told us that the review was an opportunity to put patient...
Concluded (the committee's words)
NHS England and stakeholders told us that the review was an opportunity to put patient experience and outcomes at the centre of waiting time standards. NHS England accepted that it will be important that it engages with the public regarding any changes to the current waiting times standards and how they will affect patients’ access to care and their rights under NHS Constitutions. NHS England explained that, in carrying out the review, it had consulted widely with stakeholders and patient representative bodies, for example, Healthwatch.17 The Department clarified that any proposed changes would have to be approved by the Government before being adopted. We asked the witnesses whether any changes to waiting times standards in the NHS Constitution would be subject to consultation. The Department was unable to provide us with details of what specific changes would be subject to consultation but committed to checking the law and clarify the situation with us.18 The Department subsequently wrote to us to confirm that the Secretary of State has a statutory duty to consult, including with patients, NHS staff and members of the public, on any changes to the NHS Constitution, but that there was no legal requirement to consult on changes to the Handbook to the NHS Constitution. It told us that the waiting times standards were included in the Handbook to the NHS Constitution rather than the NHS Constitution itself so, in practice, there was no legal requirement for it to consult about changes to the waiting times if the NHS Constitution remained the same. However, it confirmed that, regardless of the legal position, it was committed to holding a public consultation if any changes to waiting time standards were proposed as part of its ongoing review.19 Patient harm
14We received written evidence from Versus Arthritis, a charity, who told us that patient outcomes...
Concluded (the committee's words)
We received written evidence from Versus Arthritis, a charity, who told us that patient outcomes from joint replacement surgery are worse for those who wait for more than six months for treatment. It told us that delaying access to joint replacement surgery can lead to deterioration in an individual’s medical condition and “worse overall outcomes, ultimately costing the health and care system more”. Versus Arthritis similarly told us that patients who wait longer for treatment experience increased pain and disability compared to those with shorter waits. NHS England told us that for most patients on long waiting lists, such as those waiting for orthopaedic operations, a delay does not impact on survival, but recognised that it could mean that they are in pain for longer. It told us that a review at one trust of people waiting a long time on the elective waiting list found that two cancer patients, out of thousands of patients treated, suffered harm due to their long waits. It asserted that the cause of this had been that these cancer cases had come through an elective pathway rather than a cancer pathway.20
15NHS England told us that findings from studies of the impact of long waiting times...
Concluded (the committee's words)
NHS England told us that findings from studies of the impact of long waiting times on patient harm were not consistent and the relationship is difficult to assess. It also told us that, as the National Audit Office reported, although trusts collect data on patient harm through an incident reporting system, overseen by NHS Improvement, the data cannot be used easily to help understand the relationship between waiting times and patient harm because of the way that these data are currently collected.21 17 Qq 20, 42, 56, 57; Breast Cancer Care and Breast Cancer Now (ECC0005) 18 Qq 36–46 19 Letter from the Department for Health and Social Care, 14 May 2019 20 Q 101; Versus Arthritis (ECC0004), para 24; British Orthopaedic Association (ECC0003); C&AG’s Report, para 18 21 Q 101; C&AG’s Report, para 18 NHS waiting times for elective and cancer treatment 13
16Trusts are required to review whether patients have been harmed if they have waited more...
Concluded (the committee's words)
Trusts are required to review whether patients have been harmed if they have waited more than 52 weeks for elective care. But these data are not collected at a national level.22 NHS England told us that it expects clinicians to use their professional judgement to manage and prioritise individual patients to ensure that patients do not come to harm because of longer waiting times. But it also recognised that widespread unwarranted variations in clinical practices exists across the country. We were concerned that patients might suffer harm while waiting for elective care even if they wait for less than 18 weeks for their treatment. As Pancreatic Cancer UK told us, it is possible that some patients suffer harm while waiting to see a consultant due to longer waiting times even when no waiting times standard is breached.23 22 C&AG’s Report, para 18 23 Qq 59, 91, 93–97, 101; C&AG’s Report, para 18; Written evidence submitted by Pancreatic Cancer UK 14 NHS waiting times for elective and cancer treatment 2 Improving waiting times performance Bottlenecks in capacity
17There are wide variations in performance against waiting times standards across local areas and hospitals.
Concluded (the committee's words)
There are wide variations in performance against waiting times standards across local areas and hospitals. In 2017–18, the proportion of patients waiting less than 18 weeks for their elective care varied between 75% and 96% across clinical commissioning groups (CCGs), and from 73% to 100% across NHS trusts and NHS foundation trusts. For cancer, the percentage of patients treated within 62 days following a GP referral varied from 59% to 93% across CCGs.24
18Variations in waiting times performance is closely associated with the diagnostic capacity in the NHS.
Concluded (the committee's words)
Variations in waiting times performance is closely associated with the diagnostic capacity in the NHS. The National Audit Office found that a higher proportion of patients completing their diagnostic tests within six weeks is associated with a higher proportion of patients waiting less than 18 weeks for treatment. However, it also found there are staff shortages in specific specialties including pathologists, radiologists and radiographers, all of which are involved in diagnostics tests.25 In our 2015 report on Progress in improving cancer services and outcome in England, we highlighted the lack of capacity in diagnostics services, including shortages in diagnostics staff, and asked NHS England to assess whether the NHS had sufficient diagnostic services. NHS Improvement confirmed that there was still a big capacity issue around diagnostics which required major investment, and pointed out that, for access to MRI and CT scanners, England compared poorly to other OECD (The Organisation for Economic Co-operation and Development) countries.26
19Hospitals with a higher level of bed occupancy are more likely to perform poorly against...
Concluded (the committee's words)
Hospitals with a higher level of bed occupancy are more likely to perform poorly against the 18-week waiting times standard. Hospitals in the NHS now routinely operate with a bed occupancy rate of more than 90%. This can affect elective patient care as patients may have their elective care treatment postponed because the beds are needed for emergency admissions. The number of NHS beds has reduced by 7% (8,000) since 2010–
20Between the 12 months to March 2014 and the 12 months to November 2018, the...
Concluded (the committee's words)
Between the 12 months to March 2014 and the 12 months to November 2018, the number of referrals for elective treatment increased by 17%.28 A good understanding of what is driving rising NHS activity is needed in order to manage this demand and plan for services in the future. However, as we concluded in our recent report on NHS financial sustainability, published in April 2019, the rising demand for NHS services is not sufficiently well understood. Our report found that the ageing population accounts for approximately half of the rise in demand for NHS services across England, but other 24 Qq 47, 64; C&AG’s Report, paras 13, 2.5,3.6 and Figure 2 25 C&AG’s Report, para 2.16 26 Qq 64–66; Committee of Public Accounts, Progress in improving cancer services and outcomes in England, Forty- fifth Report of Session 2014–15, 2 March 2015 27 Qq 69–74; C&AG’s Report, paras 14, 2.17–2.19 28 C&AG’s Report, para 17; NHS waiting times for elective and cancer treatment 15 factors that contribute to rising demand are not fully understood, at a national or local level. We also found that wider socioeconomic factors such as housing, employment, and changes to benefits and universal credit, were also contributing factors.29
21The Department explained that there are three groups of factors which were driving the increase...
Concluded (the committee's words)
The Department explained that there are three groups of factors which were driving the increase in demand for elective treatment: demography, patient expectations and technology, which allowed the NHS to treat conditions which could not previously been treated. NHS England similarly told us that the increase in demand was the result of it expanding the number of interventions, such as cataract operations, knee replacements and hip replacements, and because it was “constantly pushing the boundaries of medical science”. NHS Improvement explained that up to 45% of inpatient admissions and 25% of outpatient referrals are due to a growing and ageing population. Both the Department and NHS Improvement accepted that the impact of technology and patient expectations are difficult to quantify and less researched.30
22The Department asserted that the NHS must have a system in place that is able...
Concluded (the committee's words)
The Department asserted that the NHS must have a system in place that is able to respond to changes it did not know about yet and needed a workforce that would be able to adapt to new technologies. The Department acknowledged that such a system was not yet in place.31 We asked whether the NHS is able to model the demand for its services. NHS England explained that local commissioners and sustainability and transformation partnerships (STPs) were responsible for forecasting and developing plans to meet the demand from their local populations. To support the development of local plans by STPs, NHS England committed to setting clear expectations about demographics and other demand drivers.32 Long-term plan
23In January 2019, NHS England published the NHS Long Term Plan.
Concluded (the committee's words)
In January 2019, NHS England published the NHS Long Term Plan. It committed the NHS to reducing face-to-face outpatient visits by one-third over the next five years as part of a wider attempt to manage demand.33 NHS Improvement told us that the NHS will achieve this through a “clinically-led discussion about a change in clinical practice”. NHS England explained that this would be achieved by: maximising the use of “one-stop” clinics, where tests, tests results and treatment plans are all carried out in a single visit instead of multiple ones; integrating primary and secondary care so that patients can be managed in the correct environment first time, for example, treatment by physiotherapists in the community rather than being referred to hospital; and adopting a range of technologies that are used in everyday life, such as video consultations, emails or texts, instead of face- to-face consultations when no physical examination is required.34
24NHS England told us that it expected local STPs and integrated care systems to publish...
Concluded (the committee's words)
NHS England told us that it expected local STPs and integrated care systems to publish plans this autumn which set out how the aspirations in the NHS Long Term Plan will be achieved for their local populations. It explained that the local plan will set out the STP’s “trajectory” for service changes and NHS England will bring them together “in 29 Committee of Public Accounts, NHS financial sustainability: progress review, Ninety-First Report of Session 2017–19, 3 April 2019 30 Qq 58–59 31 Q 63 32 Qq 60, 63, 68, 78 33 C&AG Report, para 22 34 Qq 75, 76 16 NHS waiting times for elective and cancer treatment the autumn as part of the national implementation plan for the NHS Long Term Plan”.35 Our report on NHS financial sustainability, published on 3 April 2019, found that there were a number of uncertainties in the budgets for capital, education and training, and adult social care which made it difficult for local partnerships to plan effectively.36 NHS England told us that it expected the next spending review to provide clarity on these budgets, but there is uncertainty over its timing. The Department stressed that it often takes many years to train clinical staff. NHS Improvement told us that it has yet to publish its people plan and that this would not be finalised until towards the end of the year after the spending review.37
25NHS England told us that it intends to reduce outpatient appointments by providing more care...
Concluded (the committee's words)
NHS England told us that it intends to reduce outpatient appointments by providing more care outside of hospitals.38 For this to happen, it will require an increase in capacity for primary and community care. NHS England told us that it will develop primary care networks for populations of 30,000 to 50,000 people where GPs are supported by multidisciplinary teams, including therapists, social prescribers, physiotherapist, and clinal pharmacists and. It told us that supporting the generalist skills of GPs with a wide range of multidisciplinary staff would allow GPs to “focus on what they do best, which is the complex conditions that they increasingly see with an ageing population”.39 35 Qq 77–81 36 Committee of Public Accounts, NHS financial sustainability: progress review, Ninety-First Report of Session 2017–19, 3 April 2019 37 Qq 90–91, 99–100, 102–108 38 Qq 53, 54 39 Q 86 NHS waiting times for elective and cancer treatment 17
Evidence
Oral evidence sessions 1
- 24 Apr 2019No witnesses recordedparliament.uk ↗