Source · Select Committees · Public Accounts Committee
Recommendation 12
12
Accepted
NHS England failed to reduce outpatient follow-up appointments, abandoning its 25% target
Conclusion
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 2023–24. The NAO reported it had not seen evidence of any assessment of the funding and resources required to achieve the 25% reduction. The NAO also reported that performance reporting was sporadic, with performance against the target only reported to NHS England’s elective recovery board in eight out of 24 months when the target was live. The reporting that did take place showed a reduction in follow-up appointments of only 0.1% (between June 2022 and July 2023). NHSE then dropped the 25% target and it has been removed from operational planning guidance and reporting packs.22
Government Response Summary
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 proposals for the further use of Advice and Guidance (A&G) asking systems to ensure all referrals go through a single point of access.
Government Response
Accepted
HM Government
Accepted
2.1 The government agrees with the Committee’s recommendation. Recommendation implemented 2.2 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. This included integrating outpatient transformation work within the elective care programme into refreshed programme governance, as well as improved reporting on performance, programme delivery and outcome tracking to the Programme Board and relevant sub-groups. 2.3 In order to deliver the commitment to improve the percentage of patients waiting no longer than 18-weeks from referral to treatment to 92% nationally by March 2029, it is essential to transform outpatient care. Outpatient care accounts for the majority of pathways on the elective waiting list, with 80% of elective pathways ending (for example through treatment or being discharged) in an outpatient setting (that is without an admission). That is why the Medium Term Planning framework (2026-27 to 2028-29) has set out ambitious proposals for the further use of Advice and Guidance (A&G) asking systems to ensure all referrals go through a single point of access, this delivers a more robust approach to triage, so patients are cared for closer to home and there are fewer outpatient appointments in secondary care. The framework requires a significant reduction in the number of clinically unnecessary follow-ups, which will be supported by Getting it Right First Time (GIRFT) and potential changes to payment for follow-up activity. This is part of a new model of planned care which will deliver the ambitions of the 10 Year Health Plan. Further details will be published in due course.