This report by the Health and Social Care Commons Select Committee looks at the catastrophic impact of the Covid-19 pandemic on patients waiting for NHS care and outlines the findings of the Select Committee's inquiry. Waiting lists are at their highest since records began, and the 5.8 million patients waiting to start treatment in September 2021 may be only the tip of the iceberg, with missing patients meaning that the true waiting list could be as high as 13 million.
The report highlights the need to carefully plan how to tackle the elective care backlog. It outlines the risks involved, including the danger of prioritising areas that are well suited to numerical targets to the detriment of other areas of care, such as mental health, general practice and community services. It also highlights that the challenges the NHS faces are greater than just tackling elective care. With a record number of 999 calls and waiting times in emergency departments at record levels, work to tackle the backlog is being threatened by pressure on emergency care.
Key recommendations of the report include:
- The Department of Health and Social Care should work with NHS England to produce a broader national health and care recovery plan that goes beyond the elective backlog to emergency care, mental health, primary care, community care and social care. This should be completed by April 2022 and must also set out a clear vision for what ‘success’ in tackling the backlog will look like to patients. In setting those metrics for success, the plan must take account of the risk that a reliance on numerical targets alone will deprioritise key services and risk patient safety. Instead, it must embrace a range of indicators to demonstrate that hidden backlogs are also being tackled and compassionate cultures encouraged.
- Primary care practices should respond to the needs of their local populations and work with patients to establish the most appropriate method for consultations, based on clinical outcomes. It is not appropriate to set a numerical target for the proportion of appointments carried out remotely in general practice.
- NHS England should publish its evaluation of the role of digital tools in primary care as soon as possible. It should be used as a basis to produce clear and consistent guidance on best practice in reducing bureaucracy and day-to-day IT administration tasks, and the use of remote consultations in general practice.
- NHS England should look beyond primary care and consider the impact of increased use of digital tools on patients and other parts of the health and care system, especially at the primary care and secondary care interface.
- NHS England should complete and publish evaluations of NHS 111 call first services as soon as is practicable, including learning from those evaluations and the implications for any future iterations of the service.
- Before the end of this financial year, NHS England must publish a Long Covid plan covering the period until 2023. The plan must be developed in consultation with a wide range of stakeholders, including patient groups. NHS England should integrate this into its wider health and care recovery plan, as Long Covid is likely to have implications for demand and workforce across a range of services.
- The NHS must make a commitment to keeping in touch with patients, many of whom currently feel 'abandoned' by services. This would not just benefit individual patients, but also help local systems actively to manage their lists and inform decisions about prioritisation.
- The national health and care recovery plan must set out a clear vision for what ‘success’ in tackling the backlog will look like, and what patients can expect their care to look like in their local area in the coming years. The plan must include minimum expectations for integrated care boards (ICBs) in managing waiting lists actively and communicating with patients awaiting planned care. The Department of Health and Social Care, NHS England and local ICBs must share responsibility for communicating the ‘offer’ to the wider public, considering the “social backlog” facing many members of the public. The Select Committee asks the Department of Health and Social Care report back to them on how this will be delivered.
- The Care Quality Commission should include consultation with patient groups and details of patient outcomes in its assessment of integrated care systems.
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