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Source · National Audit Office

Managing NHS backlogs and waiting times in England

This is our second report on backlogs for elective and cancer care. It examines the design of NHSE’s recovery plan, how the NHS has been implementing the plan and the ongoing risks NHSE has to manage.

Published: 17 Nov 2022 Recommendations: 6 Type: Value for Money NAO confirmed: 5 Department: Department of Health and Social Care
Dept: Department of Health and Social Care Topics: Health and social careNHS nao.org.uk →

Recommendations

6 items
6 accepted 6 implemented

Recommendation 1

Addressee: Department of Health and Social Care; NHS England and NHS Improvement · Source location: Page 13, Paragraph 21, point a

a) NHSE should improve its reporting indicators so it has a full set in place by the start of April 2023 at the latest. It should develop new indicators to take account of key risks (such as worsening health inequalities or health outcomes) and critical enablers within individual programmes (for instance, workforce availability, which is crucial to several initiatives).

Response position: Accepted

Delivery: Implemented · Q4 2023/24 · Confirmed by NAO

Recommendation 2

Addressee: Department of Health and Social Care; NHS England and NHS Improvement · Source location: Page 13, Paragraph 21, point b

b) Before April 2021, DHSC and NHSE should agree and publish guidance that explains clearly and fully how they define and report high-level metrics for increasing NHS activity and reducing long waits to ensure that they are transparent and consistently applied.

Response position: Accepted

Delivery: Implemented · Q2 2023/24 · Confirmed by NAO

Recommendation 3

Addressee: Department of Health and Social Care; NHS England · Source location: Page 13, Paragraph 21, point c

c) Before April 2023, NHSE should set up independent evaluations of its major elective recovery programmes so that it is actively developing the evidence base for these initiatives.

Response position: Accepted

Delivery: Implemented · Q4 2023/24 · Confirmed by NAO

Recommendation 4

Addressee: Department of Health and Social Care; NHS England and NHS Improvement · Source location: Page 13, Paragraph 21, point d.

d) In Quarter 1 of 2023-24 NHSE should review the elective and cancer recovery actions it took in 2022-23, to assess progress and any unintended effects. At the same time, DHSC and NHSE should determine whether elective recovery targets and trajectories need to be adjusted, and how to allocate recovery funding, for future years based on actual performance in 2022-23.

Response position: Accepted

Delivery: Implemented · Q4 2023/24 · Confirmed by NAO

Recommendation 5

Addressee: Department of Health and Social Care; NHS England · Source location: Page 13, Paragraph 21, point e

e) During 2022-23, NHSE should publish a report to improve transparency on the progress it is making with the recovery of elective and cancer care. This should include an assessment of the results of its major recovery initiatives, including its approaches to reducing cohorts of long-waiters, CDCs, surgical hubs, outpatient transformation, and increasing specialist advice and guidance. NHSE should then consider whether the report should become annual for the duration of the recovery.

Response position: Accepted

Delivery: Implemented · Q4 2024/25

Recommendation 6

Addressee: NHS England and NHS Improvement · Source location: Page 13, Paragraph 21, point f

f) In 2024-25, with the benefit of two years of managing elective recovery, DHSC and NHSE should develop a long-term plan for returning elective and cancer services to a state in which legal and operational waiting time standards are met. DHSC should publish the plan so the public can understand at a high level how the recovery will continue after March 2025.

Response position: Accepted

Delivery: Implemented · Q3 2025/26 · Confirmed by NAO

Public Accounts Committee follow-up

1 report

The Public Accounts Committee examined this NAO report and published its own recommendations. The government responds to PAC recommendations via Treasury Minutes.