Omicron and emergency care crisis could derail plans to tackle backlog, warn MPs 

Government plans to deal with a record 5.8 million waiting list for elective care risk being overturned by a crisis in emergency care. The Health and Social Care Committee’s Report on clearing the backlog caused by the pandemic finds that the elective recovery plans are threatened by pressure on emergency care with a record number of 999 calls and waiting times in emergency departments at record levels.  

The Report concludes that tackling the wider backlog caused by the pandemic is a major and ‘unquantifiable’ challenge. It calls for a broad national health and care recovery plan to include mental health, primary care, community care, and social care as well as emergency care.  

It finds better workforce planning to be a central factor in recovery. However, the Report notes that the Government resisted changes to the Health and Care Bill that would have required publication of an independent assessment of workforce numbers at least once every two years. Without it, it will remain impossible to know whether enough doctors, nurses or care staff are being trained, say MPs.  

A focus on waiting lists, at the highest levels since records began, is understandable but a numerical target driven approach risks jeopardising equally important areas of care that keep people healthy and out of hospital, the Committee says.  

Health and Social Care Committee Chair Rt Hon Jeremy Hunt MP said: 

“The NHS faces an unquantifiable challenge in tackling a backlog of cases caused by the pandemic, with 5.8 million patients waiting for planned care and estimates that the figure could double by 2025.  

“However, our Report finds that the Government’s recovery plans risk being thrown off course by an entirely predictable staffing crisis. The current wave of Omicron is exacerbating the problem, but we already had a serious staffing crisis, with a burnt-out workforce, 93,000 NHS vacancies and no sign of any plan to address this.   

“Far from tackling the backlog, the NHS will be able to deliver little more than day to day firefighting unless the Government wakes up to the scale of the staffing crisis facing the NHS, and urgently develops a long-term plan to fix the issue.” 

ENDS 

Key recommendations: 

·       Department of Health and Social Care urged to work with NHS England to produce a broader national health and care recovery plan by April 2022, that goes beyond the elective backlog to emergency care, mental health, primary care, community care and social care. 

·       Plan must take account of the risk that a reliance on numerical targets alone will deprioritise key services and risk patient safety. 

·       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. 

·       Repeats Committee’s previous recommendation for publication of independently audited annual reports on workforce projections that cover the next five, ten and twenty years, including an assessment of whether enough staff are being trained. 

Emergency departments: 

The Report notes that waiting times in October 2021 were the worst since records began, with one in four patients waiting longer than four hours to be admitted, transferred or discharged and trolley waits at a record high. October also saw the highest number of 999 calls on record. 

A ‘beefed-up’ version of NHS 111 had enormous potential to regulate the demands on emergency departments and ensure that patients get the right care, in the right place, at the right time  - however clinical validation was needed. MPs urge NHS England to publish evaluations of the ‘call first’ services to avoid missing opportunities to improve services. 

Workforce planning and training: 

The inquiry heard that workforce shortages were the 'key limiting factor' on success in tackling the backlog. Several witnesses said that no financial settlement would be sufficient without enough action on workforce. Funding for the training of new doctors and nurses through Health Education England was described as “absolutely critical” to clearing the backlog and for the future of the NHS by Professor Stephen Powis, NHS England’s National Medical Director. He, along with NHS CEO Amanda Pritchard, identified real concerns over any reduction or freezing of HEE’s budget. The Report notes it was particularly disappointing that a funding settlement was absent from the Spending Review that took place a week later. Given the pressures faced by the NHS, MPs say it was “extremely disheartening” that there appeared not to have been discussion about increasing numbers entering training.  

Scale and impact of backlog: 

The Report catalogues the scale and impact of the backlog: in September 2021, 5.8 million people were waiting for planned care, with 300,000 waiting more than a year and 12,000 more than two years.  

There were 'historically high' levels of presentation in mental health with the Royal College of Psychiatrists presenting evidence of a 94% increase in the number of children being referred to child and adolescent mental health services (CAMHS) in May 2021.  

In general practice, appointments fell by a third in early months of the pandemic. The inquiry heard that there were not enough GPs to meet the needs of an expanding ageing population with complex needs and manage the fallout from the pandemic. A high number of GPs were quitting the profession, a problem likely to be exacerbated by the pandemic, MPs were told. The Secretary of State in November told the Committee that attempts to recruit 6,000 additional GPs by 2024 were not "on track", with MPs noting their concern at the implications of the shortfall.  

Long covid: 

The inquiry heard heart-rending testimony from people who had struggled to access the care they needed and who did not feel believed or cared for, which the report find was ‘simply not acceptable’. NHS England’s plan for tackling long covid must be extended beyond 2022 to 2023, say MPs. 

Communication: 

In powerful testimony to the inquiry, patients described feeling “abandoned” by the NHS, having to “fight” for care, with delays in treatment meaning ongoing uncertainty and lives put on hold. The Report finds it unacceptable that patients awaiting planned treatment or experiencing the debilitating effects of long covid should feel the NHS has abandoned them. It calls for Integrated Care Boards to actively manage waiting lists and better communicate with patients on waiting lists.