House of Commons Committee of Public Accounts report: NHS backlogs and waiting times in England (16 March 2022)

Summary

This is the report and formal minutes of a House of Commons Public Accounts Committee session that examined the issues surrounding NHS backlogs and waiting times in England. The session particularly focused on accountability in how NHS England and the Department for Health and Social Care manage workforce and resources.

At the end of December 2021, 6.07 million patients were waiting for elective care, the biggest waiting list since records began. Only 64% (3.87 million) of these patients had been waiting for less than 18 weeks, compared with the performance standard which requires 92% to have been waiting for less than 18 weeks. Similarly, in December 2021, only 67% of patients with an urgent referral for suspected cancer were treated within 62 days compared with a requirement for 85% to be treated within that time. The report highlights that although the Covid-19 pandemic had a significant effect on the backlog, NHS waiting time performance had declined steadily in the years before the pandemic.

Content

The Public Accounts Committee made six conclusions and recommendations:

1. The Department has overseen years of decline in the NHS’s cancer and elective care waiting time performance and, even before the pandemic, did not increase capacity sufficiently to meet growing demand. Recommendation: The Department must strengthen its arrangements for holding NHSE&I to account for its performance against waiting times standards for elective and cancer care. This should include specific expectations for improving waiting time performance in 2022–23. The Department should write to the Committee alongside its Treasury Minute response to set out the specific and measurable performance indicators for elective and cancer care it has put in its 2022–23 mandate to NHSE&I.
2. At the Committee evidence session, the Department and NHSE&I appeared unwilling to make measurable commitments about what new funding for elective recovery would achieve in terms of additional NHS capacity and reduced patient waiting times. Recommendation: In implementing its elective recovery plan, NHSE&I should set out clearly: timeframes, costs and outputs of the components of the recovery plan, recovering elective care and cancer care to 2024–25; the longer-term investments and plans that are being made now to improve the resilience of elective care and cancer care beyond 2024–25; and the national performance levels expected in each year between now and 2024–25.
3. The NHS will be less able to deal with backlogs if it does not address longstanding workforce issues and ensure the existing workforce, including in urgent and emergency care and general practice, is well supported. Recommendation: In implementing its recovery plan, NHSE&I’s should publish its assessment of how the size of the NHS workforce (GPs, hospital doctors and nurses) will change over the next three years, so that there is transparency about the human resources that the NHS has available to deal with backlogs.
4. It will be very challenging for the NHS to focus sufficiently on the needs of patients when it comes to dealing with backlogs, both patients already on waiting lists and those who have avoided seeking or been unable to obtain healthcare in the pandemic. Recommendation: The Department and NHSE&I must ensure there is a strong focus on patient needs in all their recovery planning, including: measuring the success of all initiatives to encourage patients to return to the NHS for diagnosis and treatment; creating guidance and tools, and setting aside resources, for meaningful communication with patients who are waiting; and supporting NHS trusts through planning guidance and other means to prioritise patients fairly, so they are able to strike an appropriate balance between clinical urgency and absolute waiting time.
5. Waiting times for elective and cancer treatment are too dependent on where people live and there is no national plan to address this postcode lottery. Recommendation: NHSE&I should investigate the causes of variations between its 42 geographic areas and provide additional support for recovery in those that face the biggest challenges. NHSE&I should write to the Committee in December 2022 on the actions it has taken to address geographical disparities in waiting times for cancer and elective care and include a summary of any analysis it has done on differences in health outcomes for elective and cancer care in different parts of the country since the start of the pandemic.
6. For the next few years it is likely that waiting time performance for cancer and elective care will remain poor and the waiting list for elective care will continue to grow. Recommendation: The Department and NHSE&I must be realistic and transparent about what the NHS can achieve with the resources it has and the trade-offs that are needed to reduce waiting lists. In implementing its elective recovery plan, NHSE&I should set out clearly what patients can realistically expect in terms of waiting times for elective and cancer treatment. By the time of the next Spending Review at the latest, the Department and NHSE&I should have a fully costed plan to enable legally binding elective and cancer care performance standards to be met once more.