Source · Select Committees · Public Accounts Committee
Thirty-Eighth Report - Managing NHS backlogs and waiting times in England
Public Accounts Committee
HC 729
Published 1 March 2023
Conclusions (13)
5
Conclusion
Acknowledged
NHSE started 2022–23 with a strategy but spent most of the year dealing with tactical issues and its strategic and programme management of the recovery must improve. NHSE was allocated £14 billion of recovery funding in September 2021 (for the three years from April 2022) and published its recovery plan …
Government Response Summary
The government acknowledges the need to improve strategic and programme management of recovery and describes monitoring and support structures in place for providers at the highest risk and efforts to address health inequalities.
1
Conclusion
Acknowledged
On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health (the Department) and NHS England (NHSE) about NHS backlogs and waiting times in England.1
Government Response Summary
The government acknowledges the committee's conclusion regarding NHS backlogs and waiting times and states their commitment to reducing cancer waiting times.
10
Conclusion
Acknowledged
We shared our concerns about the risks facing the NHS and its ability to deliver the recovery targets and we pressed NHSE on how confident it was that it would meet the target to increase elective activity to 129% of 2019–20 levels by 2024–25.20 In some ways, this is the …
Government Response Summary
The Department and NHS England have stepped up actions to tackle the backlog and the ambitions in the Delivery Plan were agreed between NHS England and the government, based on detailed modelling and available funding at the time.
11
Conclusion
Acknowledged
Macmillan Cancer Support and Healthwatch Suffolk submitted evidence to us containing powerful examples of the uncertainty, anxiety and other problems long waits cause patients. Macmillan Cancer Support told us that the impact of cancer care backlogs was being felt by people at all stages of the cancer pathway and that …
Government Response Summary
The government states that the department and NHS England have stepped up actions to tackle the backlog since the publication of the Delivery Plan for tackling the COVID-19 backlog of elective care.
12
Conclusion
Acknowledged
The Department has allocated £14 billion to NHS England from 2022–23 to 2024–25 specifically to recover elective and cancer care, comprising £8 billion of resource funding and £5.9 billion of capital funding, as described in the November 2021 Budget and Spending Review.24 The Autumn Statement in November 2022 then, separately, …
Government Response Summary
The government announced an additional £3.3 billion for each of 2023-24 and 2024-25 and at the 2021 Spending Review, £14 billion was made available to the NHS to support Elective Recovery and NHS England will write to the Committee before summer recess to set out further detail on how funding available for elective recovery will be spent.
13
Conclusion
Acknowledged
We asked NHSE about whether, in its view, this would provide the NHS with sufficient funding, given its previous comments about the scale of the negative impact inflation had had on its budgets.26 The Chief Executive told us that it should be enough to deliver key priorities, including elective and …
Government Response Summary
The government announced an additional £3.3billion for each of 2023-24 and 2024-25 to support the NHS in England. NHS England will write to the Committee before summer recess to set out further detail on how funding available for elective recovery will be spent, together with details of its evaluation plans and initiatives to improve productivity.
14
Conclusion
Acknowledged
NHSE has estimated that the NHS was around 16% less productive in 2021 than before the pandemic.29 NHSE’s internal analysis indicated that this drop in productivity was not solely due to immediate pandemic pressures, but also resulted from staff being less likely to work paid or unpaid overtime, and a …
Government Response Summary
The government outlines actions to increase activity, manage demand and increase productivity, stating that NHS England monitors progress and has published planning guidance.
15
Conclusion
Acknowledged
NHSE’s elective recovery programme includes plans for: • GPs to handle many elective cases previously dealt with by hospital doctors. Instead of referring some patients for elective care, GPs manage them within the 24 C&AG’s Report, paras 7, 1.15; Autumn Budget and Spending Review 2021, para 2.11 25 Autumn Statement …
Government Response Summary
The government highlights actions in the NHS published Delivery Plan are targeted at increasing activity, managing demand or increasing productivity and NHS England carefully monitors progress against delivery targets at regular intervals.
16
Conclusion
Acknowledged
We asked how confident NHSE was about the component programmes in its plan, particularly those aimed at increasing elective and diagnostic capacity. It told us that it did not have strong evidence for some of its programmes at present, but said it was building evaluation into its programmes on surgical …
Government Response Summary
The government outlines actions to increase activity, manage demand and increase productivity, stating that NHS England monitors progress and has published planning guidance; NHS England will write to the Committee before summer recess to set out further detail of the impact of community diagnostic centres, surgical hubs, use of the independent sector, and the advice and guidance programme.
17
Conclusion
Acknowledged
Surgical hubs and community diagnostic centres have potential, but success will rely on them being adequately staffed. NHSE currently has limited evidence on hubs’ and CDC’s ability to continue operating when the wider NHS is under significant pressure.36 The Royal College of Surgeons also acknowledged the value of a thorough …
Government Response Summary
The government outlines actions to increase activity, manage demand and increase productivity, stating that NHS England monitors progress and has published planning guidance; NHS England will write to the Committee before summer recess to set out further detail of the impact of community diagnostic centres, surgical hubs, use of the independent sector, and the advice and guidance programme.
18
Conclusion
Acknowledged
We also asked NHSE whether its increased use of the independent healthcare sector might detract from or reduce activity within the NHS itself. NHSE told us that this was a key consideration in decisions about when to use the independent sector. It confirmed that it was working to support NHS …
Government Response Summary
The government outlines actions to increase activity, manage demand and increase productivity, stating that NHS England monitors progress and has published planning guidance; NHS England will write to the Committee before summer recess to set out further detail of the impact of community diagnostic centres, surgical hubs, use of the independent sector, and the advice and guidance programme.
20
Conclusion
Acknowledged
NHSE told us that it monitored performance constantly, with fresh data available weekly, and that it was continually developing the metrics it uses to track performance. It argued that this was a comprehensive and agile approach.40 We heard how NHSE uses data to place NHS providers into tiers, depending on …
Government Response Summary
The government agrees and outlines actions taken, including provider assessments, additional support for high-risk providers, monitoring, and addressing health inequalities, with ICBs expected to develop delivery plans.
21
Conclusion
Acknowledged
In response to our question about improving areas that have seen long-term underperformance, sometimes dating back to before the pandemic, NHSE told us that it had sent teams into some areas to support and challenge them.42 The National Audit Office report showed that the proportion of waiting patients who are …
Government Response Summary
The government agrees and outlines actions taken, including provider assessments, additional support for high-risk providers, monitoring, and addressing health inequalities, with ICBs expected to develop delivery plans.