Source · Select Committees · Public Accounts Committee
Recommendation 14
14
Accepted
Outpatient transformation hampered by industrial action, under-resourcing, and organisational challenges
Conclusion
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 outpatients and that the programme was under-resourced.27 Other organisational factors also hindered NHSE’s oversight and control of the programme, as in its early stages, outpatients transformation was managed by a different part of NHSE from the other transformation programmes.28 NHSE also accepted that more work needs to be done on outpatients transformation.29
Government Response Summary
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 of access, reduced follow-ups and use of technology.
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.