Source · Select Committees · Public Accounts Committee
Recommendation 5
5
Rejected
Improve accountability for NHS England's urgent and emergency care performance, articulating roles and monitoring steps.
Conclusion
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 and that, together, they hold a shared analysis of the key issues in urgent and emergency care and an agreed view on the solutions that are needed. However, the NHS has not met targets for ambulance handovers since November 2017 and for A&E waits since July 2015, with wider declines in performance across the board. Against this background, we asked how effective the Department has Access to urgent and emergency care 7 been in holding NHS England to account for the declining performance. While the Department was at pains to say how closely it worked with NHS England and had a shared analysis, it did not articulate how it was adding any value in holding NHS England to account for making meaningful improvements to services for patients. Recommendation 5: The Department must improve how effectively it holds NHS England to account for performance against targets for access to urgent and emergency care. It should clearly articulate the respective roles of the Department and NHS England and set out the key steps the Department takes when its monitoring highlights underperformance.
Government Response Summary
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 by clear metrics.
Government Response
Rejected
HM Government
Rejected
The government disagrees with the Committee’s recommendation. While the department approaches all its work in a spirit of continuous improvement, the government nonetheless disagrees with the Committee's recommendation. Parliament has itself articulated the respective roles of the Secretary of State and NHS England in the NHS Act 2006 as subsequently amended (most recently by the Health and Care Act 2022). The department maintains effective oversight of NHS England, including over urgent and emergency care and the actions being taken to address the impact of the pandemic and long-term sectoral challenges under the Delivery Plan for recovering urgent and emergency care services. The Secretary of State for Health and Social Care is accountable to parliament and the public for health and care and sets objectives NHS England must seek to achieve through the mandate to NHS England, last published in June 2023. This is assessed annually, bringing together governance for performance against individual objectives in the mandate. The mandate for 2023-24 includes the achievement of urgent and emergency care recovery ambitions. NHS England has responsibilities for the oversight and support of health service providers and intervening in the case of poor performance. The NHS Oversight Framework details the overall principles, responsibilities and ways of working for oversight, including the key metrics and factors NHS England will consider when determining support needs, and the circumstances in which it considers formal regulatory intervention may be necessary to address issues. NHS England has also implemented an urgent and emergency care tiering performance and improvement approach to support the delivery of recovery ambitions under the delivery plan, providing targeted support to challenged systems and ambulance trusts on performance issues. The department maintains close oversight of NHS England’s delivery of emergency care recovery ambitions, including through regular ministerial progress meetings, ongoing engagement with No10 and regular stocktakes led by the Prime Minister. This oversight is underpinned by clear metrics agreed in the Urgent and Emergency Care recovery plan. Headline commitments to improve ambulance and accident and emergency waiting times are closely monitored through official public statistics and a wide range of management information. This informs discussions with the NHS on how to work together to address underperformance.