PAC calls for clarity over recovery plan targets

16 March 2022 Steve Brown

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The Commons Public Accounts Committee criticised the Department of Health and Social Care for overseeing ‘years of decline in the NHS’s cancer and elective care waiting time performance’. The report – NHS backlogs and waiting times in England – stressed that even before the Covid-19 pandemic, capacity had not been increased sufficiently to meet growing demand.Meg.Hillier L

At the end of December, more than six million patients were waiting for elective care. And just 64% had been waiting for less than 18 weeks, despite a requirement for 92% of patients to be seen within this time.

In addition, 311,000 had been waiting for more than one year. This is not just a consequence of Covid-19, with just 13% being seen within 18 weeks before the pandemic.

Just 67% of patients with an urgent referral for suspected cancer were treated with 62 days, compared to the 85% requirement.

Despite demand rising faster than supply, the Department did not adjust waiting times standards to realistic levels, nor did it seek to hold NHS England and NHS Improvement to account adequately. The cross-party MPs called for specific expectations for waiting time performance in 2022/23 to be published.

NHS England and NHS Improvement will receive an extra £8bn for elective care recovery and £5.9bn for capital between 2022/23 and 2024/25. On the back of this funding, it expects elective activity to be 30% higher than pre-pandemic levels. However, the committee said there was no ‘meaningful detail’ on what the money would be spent on. NHS England and NHS Improvement have suggested that key measures such as extra theatres, surgical hubs and new diagnostic facilities would add 566 beds to the number available for elective care. But the committee said this seemed small compared with the scale of the problem.

It called for NHS England and NHS Improvement to set out clearly the timeframes, costs and outputs of the components of the recovery plan covering elective and cancer care to 2024/25. Longer term investments and plans to improve the resilience of elective care and cancer care beyond 2024/25 were also needed. And it demanded to know the national performance levels expected in each year between now and 2024/25.

The committee also said long-standing workforce issues must be addressed. It called on NHS England and NHS Improvement to publish an assessment of how the size of the NHS workforce will change over the next three years.

Meg Hillier (pictured), the committee’s chair, said the PAC was ‘extremely concerned’ about the lack of a real plan to turn the investment into better outcomes for patients. ‘Nor is it obvious that the Department finally understands that it’s biggest problem, and the only solution to all its problems, is the way it manages its greatest resource: our heroic NHS staff,’ she said.

Staff were exhausted after two-years fighting Covid and there continue to be staffing shortages in a number of professional areas. ‘The cycle of glib headlines and fiddling with management structures must be broken, with an overhauled “people plan” that gets to the core of the desperate under-staffing and under-resourcing that have undermined our health system,’ Dame Meg added.

Saffron Cordery, deputy chief executive of NHS Providers, said it would take time to address backlogs, which were not confined to elective hospital care. Managing waiting lists was a complex process, especially as patients are often presenting with more severe conditions than before the pandemic. ‘Trusts will continue to prioritise those with the greatest clinical need, those waiting the longest, and seek to close the health inequalities gap,’ she said.

She agreed with the committee that lack of staff was the biggest problem in tackling treatment delays. ‘The government must set out the concrete action it will take to tackle the 110,000 staff vacancies and provide a sustainable workload for the workforce,’ she added.Matthew.Taylor l

Matthew Taylor (pictured), chief executive of the NHS Confederation, said the NHS was treating more patients than ever and was committed to the 30% increase in activity. There were also improvements in cancer checks and referrals. But he also highlighted staff shortages as a major obstacle. ‘We have over 110,000 vacancies and still no sign of a long-term, fully costed plan for growing the size of the workforce,’ he said. ‘Until we find a credible way of addressing these shortages then we won’t make the inroads into the care backlog that are required.’

He added that the NHS also faced major uncertainty over the number of patients that could yet come forward for treatment after staying away during Covid. ‘We could be looking at up to nine million missing referrals of patients for elective care, with anything up to 740,000 missing urgent referrals for suspected cancer,’ he said.

However, there was some concern about the calls for further accountability measures. ‘We need to have meaningful and achievable standards and be upfront with the public about the pace of NHS recovery following the huge shock of the pandemic,’ said Sarah Scobie, Nuffield Trust deputy director of research. ‘While it is right that MPs highlight the need for the government to hold NHS leaders to account, the health service needs to focus on improving patient care and eradicating backlogs rather than reporting more metrics.'