NHS England’s plan to reduce long waiting lists for elective care by 2025 is at serious risk, the government’s spending watchdog has warned. A report from the National Audit Office, published on 17 November,1 found major workforce problems, productivity at a lower level than before the covid pandemic and funding that has not kept pace with inflation.
It follows a delayed plan from NHS England, published in February 2022,2 which set out how it would deal with backlogs and long waiting lists over the next three years.
The sharp increase in elective activity expected by NHS England to meet its goals—which involves reaching 129% of 2019-20 levels—would be an “historic feat,” the report warned. Even if it were achieved, NHS England has not been able to show it would be enough to meet the commitments set out in its plan, the NAO said. And there are many risks and challenges threatening to push recovery further off track, including unfilled posts, worsening staff morale, and widening health inequalities.
In its last report on waiting times, in 2021,3 the NAO noted that the NHS had not met elective care standards for four years or targets for cancer services for eight years.
So far in 2022-23, overall elective care has been below the planned trajectory, the new report said, partly because of circumstances that have proved tougher than assumed, with covid-19 continuing to put pressure on services. Some progress has been made on the longest waits of more than two years, but the overall waiting list has continued to increase and now stands at seven million patients, it noted.
Urgent referrals from GPs for cancer were up 15%, but figures up to August showed that only 62% of patients began treatment within 62 days, whereas before the pandemic the figure was 78%, the report said.
In all, 26 of England’s 42 integrated care systems have said they will not reach their 2022-23 target of delivering 104% of pre-pandemic elective activity.
The report also raised concern about the limited evidence of effectiveness for some initiatives within the recovery plan, including use of advice and guidance systems and surgical hubs and community diagnostic centres.
The Department of Health and Social Care and NHS England should review the progress of the recovery plan in early 2023-24 to decide whether targets and funding allocations need to be adjusted and to more clearly define how activity and long waits are measured, the NAO concluded.
Gareth Davies, its head, said, “There are significant risks to the delivery of the plan to reduce long waits for elective and cancer care services by 2025.
“The NHS faces workforce shortages and inflationary pressures, and it will need to be agile in responding as the results of different initiatives in the recovery programme emerge.”
Meg Hillier, chair of the House of Commons Committee of Public Accounts, said that fixing NHS backlogs was a “monumental challenge” and that the committee had previously warned against overoptimistic plans. “Patients will continue to suffer the consequences if NHS England doesn’t act now to improve its management of the programme,” she said.
Siva Anandaciva, chief analyst at the health think tank the King’s Fund, warned that the report should ring alarm bells in government. “NHS funding is not keeping pace with inflation, plus staffing shortages and covid-19 cases in the wider health and social care system are still endemic—all of which put government targets to reduce hospital waiting lists in jeopardy.”
An NHS spokesperson said the NHS was currently on track to deliver on its next recovery milestones, after already virtually eliminating two year waits for care and reducing 18 month waits by almost 60% in a year.
“Staff have achieved this despite higher staff absences, more covid patients in hospital this summer than the last two combined, reduced hospital capacity caused by social care issues discharging patients back into the community, and increased demand on urgent and emergency care services,” the spokesperson said.
NHS England’s plan to reduce long waiting lists for elective care by 2025 is at serious risk, the government’s spending watchdog has warned. A report from the National Audit Office, published on 17 November,1 found major workforce problems, productivity at a lower level than before the covid pandemic and funding that has not kept pace with inflation.
It follows a delayed plan from NHS England, published in February 2022,2 which set out how it would deal with backlogs and long waiting lists over the next three years.
The sharp increase in elective activity expected by NHS England to meet its goals—which involves reaching 129% of 2019-20 levels—would be an “historic feat,” the report warned. Even if it were achieved, NHS England has not been able to show it would be enough to meet the commitments set out in its plan, the NAO said. And there are many risks and challenges threatening to push recovery further off track, including unfilled posts, worsening staff morale, and widening health inequalities.
In its last report on waiting times, in 2021,3 the NAO noted that the NHS had not met elective care standards for four years or targets for cancer services for eight years.
So far in 2022-23, overall elective care has been below the planned trajectory, the new report said, partly because of circumstances that have proved tougher than assumed, with covid-19 continuing to put pressure on services. Some progress has been made on the longest waits of more than two years, but the overall waiting list has continued to increase and now stands at seven million patients, it noted.
Urgent referrals from GPs for cancer were up 15%, but figures up to August showed that only 62% of patients began treatment within 62 days, whereas before the pandemic the figure was 78%, the report said.
In all, 26 of England’s 42 integrated care systems have said they will not reach their 2022-23 target of delivering 104% of pre-pandemic elective activity.
The report also raised concern about the limited evidence of effectiveness for some initiatives within the recovery plan, including use of advice and guidance systems and surgical hubs and community diagnostic centres.
The Department of Health and Social Care and NHS England should review the progress of the recovery plan in early 2023-24 to decide whether targets and funding allocations need to be adjusted and to more clearly define how activity and long waits are measured, the NAO concluded.
Gareth Davies, its head, said, “There are significant risks to the delivery of the plan to reduce long waits for elective and cancer care services by 2025.
“The NHS faces workforce shortages and inflationary pressures, and it will need to be agile in responding as the results of different initiatives in the recovery programme emerge.”
Meg Hillier, chair of the House of Commons Committee of Public Accounts, said that fixing NHS backlogs was a “monumental challenge” and that the committee had previously warned against overoptimistic plans. “Patients will continue to suffer the consequences if NHS England doesn’t act now to improve its management of the programme,” she said.
Siva Anandaciva, chief analyst at the health think tank the King’s Fund, warned that the report should ring alarm bells in government. “NHS funding is not keeping pace with inflation, plus staffing shortages and covid-19 cases in the wider health and social care system are still endemic—all of which put government targets to reduce hospital waiting lists in jeopardy.”
An NHS spokesperson said the NHS was currently on track to deliver on its next recovery milestones, after already virtually eliminating two year waits for care and reducing 18 month waits by almost 60% in a year.
“Staff have achieved this despite higher staff absences, more covid patients in hospital this summer than the last two combined, reduced hospital capacity caused by social care issues discharging patients back into the community, and increased demand on urgent and emergency care services,” the spokesperson said.
