PAC: First year of NHS England’s three-year recovery programme already falling short of expectations
|
Record waits for cancer care and elective care wait list at 7
million patients Proportion of people receiving timely cancer
treatment has actually decreased Target to reduce the number of
people waiting overlong for urgent referral will not be met Target
for recovering elective care is unachievable In a report today the
Public Accounts Committee says cancer waiting times are at their
worst recorded level and NHS England will not meet its first cancer
recovery...Request free trial
In a report today the Public Accounts Committee says cancer waiting times are at their worst recorded level and NHS England will not meet its first cancer recovery target. Though the first target for elective care was to eliminate two-year waits by July 2022, in August 2022 there were 2,600 patients who had been waiting more than two years, and a record 7 million people on waiting lists in total. NHS England made unrealistic assumptions about the first year of recovery, including that there would be low levels of COVID-19 and minimal adverse effects from winter pressures. The Committee expresses serious doubts that the wider NHS recovery plan will be achieved to time. The NHS is still not planning properly for the staffing and other resources it needs to deliver additional diagnostic and treatment capacity, though much of it was already needed before the COVID-19 pandemic. The Committee says NHS England must act now on two areas that most obviously need new, effective planning to enable recovery. The first is to increase the capacity of adult social care so that the flow through hospitals improves. The second is to finally get the years overdue strategy in place to create a productive healthcare workforce of the right size. This requires clarity and reality about how long that will take to achieve through domestic training. Dame Meg Hillier MP, Chair of the Public Accounts Committee, said: “Despite a significant cash injection meant to begin to help the recovery from the pandemic, the NHS is in full blown crisis and all the metrics are going in the wrong direction. On the evidence we have received the NHS will not achieve the targets in its recovery plan, and that means health, longevity and quality of life indicators will continue to go backwards for the people of this country. That is simply shameful, and totally unacceptable in a nation as wealthy as ours. “NHS England must lift its sights and refocus on its strategic duty to offer direction to the whole NHS. This means difficult trade-offs to address historical inequalities between areas, to reconstitute a depleted, exhausted workforce that is on its knees, and to rebuild a crumbling physical estate that is in dangerous condition in many places. We do not expect the NHS to achieve the significant and ambitious targets of its current recovery plan, but it must now step up and show that leadership for a realistic way forward, with targets that have patients seeing the real improvements.” Conclusions and recommendations 7 Cancer waiting times are at their worst recorded level and NHS England (NHSE) will not meet its first cancer recovery target. 85% of people who have been urgently referred by their GP and have cancer confirmed should start treatment within 62 days. But in the first five months of 2022-23, only 62% of patients met this target, with 11% of patients being treated more than 104 days after an urgent referral. NHSE set a recovery target that the weekly count of patients waiting over 62 days would recover to the pre-pandemic level by March 2023, and in July 2022 the Chief Executive of the NHS wrote to all NHS trusts stating that cancer care was a critical priority for the rest of the year. However, in evidence to us at the end of November, NHSE acknowledged that this first cancer recovery target would be missed. Recommendation: NHS England should be able to treat 85% of people with cancer within 62 days of an urgent GP referral and no one should ever have to wait more than 104 days for cancer treatment. It is unacceptable that 8,100 people waited over 104 days in the first five months of 2022-23. As a matter of urgency, the Department of Health and Social Care and NHS England should do whatever is required to bring cancer treatment back to an acceptable standard. 8 NHS England was over-optimistic about the circumstances in which the NHS would be trying to recover elective and cancer care. In our first report on NHS backlogs and waiting times in March 2022, we reported our concern that “officials are too optimistic about the resilience of NHS services in the short- and medium-term, particularly as NHS staff have been working under continuously high pressure during the pandemic”. The recovery plan, however, continued this over-optimism by including assumptions about low levels of COVID-19 and minimal winter pressures, and that activity levels would recover to pre-pandemic levels early in 2022-23. Between April and August 2022, elective activity was at just 95% of pre-pandemic levels. The reality has been that the NHS continues to manage other major pressures, including ongoing effects of COVID-19, access to primary care, the performance of urgent and emergency care, workforce gaps, and problems with the supply of adult social care. NHSE told us that it would need to “reprofile” the trajectory of the recovery if it was to reach 129% during 2024-25. Macmillan Cancer Support and Healthwatch Suffolk submitted evidence to us with powerful examples of the uncertainty, anxiety and other problems experienced by long-waiting patients. Recommendation: NHS England and the Department of Health and Social Care should revisit their planning assumptions for the recovery and publicly report any updates to targets so that patients and NHS staff can see a clear and realistic trajectory to achieve the 62-day cancer backlog target, the 52-week wait target for elective care, and, ultimately, the 18-week legal standard for elective care. 9 NHS funding has increased, but to deliver key priorities such as elective and cancer recovery it will need to be spent in the most cost-effective way. The Department has allocated £14 billion to NHSE from 2022-23 to 2024-25 specifically to recover elective and cancer care. This comprises £8 billion of resource funding and £5.9 billion of capital funding. The Autumn Statement 2022 committed an additional £3.3 billion in 2023-24 and 2024-25 to the NHS budget as a whole. NHSE told us this would be sufficient for the NHS to deliver its key priorities. However, NHSE has opted not to produce a detailed costed version of its recovery plan to show how it expects all of the £14 billion to be spent. Without timely evaluation of its programmes, including surgical hubs and clinical diagnostic centres, there is a risk that the future allocation of resources will not be informed by reality on the ground. Overall, the NHS has a problem with reduced productivity. An internal review by NHS England estimated that the NHS was around 16% less productive in 2021 than in 2019 and said that the immediate effects of the pandemic were not the only cause. Recommendation: NHSE should transparently describe how the additional funds for elective recovery have been allocated. Alongside the Treasury Minute response, it should also write to us providing details of the programmes on which it expects the £14 billion to be spent, the independent evaluations it has put in place to monitor the effectiveness of additional spending, and how it expects additional spending to improve NHS productivity. 10 NHS England’s elective recovery programme partly relies on initiatives which have potential but for which there is so far limited evidence of effectiveness. NHSE has expanded some programmes because it believes them to be sufficiently promising, but there is currently a limited evidence base for their effectiveness, their impact on other parts of the health and social care system, and how they will work on a greatly expanded scale. NHSE told us it would ensure that capacity in surgical hubs, community diagnostic centres and the independent sector would be genuinely additional. However, it has more work to do to demonstrate how additional capacity will be sufficiently staffed without detracting from other NHS services. It is also concerning that NHSE could not provide the National Audit Office with its full evaluation of the 2021 elective accelerators programme, on which it spent £160 million. Recommendation: NHS England should know more about the conditions necessary for individual programmes to make the greatest contribution possible to recovery. Alongside its Treasury Minute response to this report, it should write to us more fully describing the real-world impact of community diagnostic centres, surgical hubs, increased use of the independent sector, and the advice and guidance programme. It should set out its understanding of the extent to which these initiatives have so far generated genuinely additional activity, rather than simply displacing activity elsewhere in the NHS. 11 NHSE started 2022-23 with a strategy but spent most of the year dealing with tactical issues and its strategic and programme management of the recovery must improve. NHSE was allocated £14 billion of recovery funding in September 2021 (for the three years from April 2022) and published its recovery plan in February 2022. But it had only filled seven out of 21 programme management posts by the end of May 2022 and still did not have the capability to report fully on performance in August 2022. NHSE told us that it had developed a comprehensive and agile approach to sharing best practice between areas and was supporting and challenging leaders. However, it is unclear whether this approach will be sufficient to address the scale of the challenge in the worst-performing areas, or whether better strategic management is required to address the underlying causes of variation. Recommendation: NHS England must lift its sights and refocus on its strategic duty to offer direction to the whole NHS. This should involve making difficult trade-offs to address historical inequalities between areas, and by having a clear set of actions to improve leadership. To demonstrate progress, NHS England should write to us by the Summer recess setting out the action is has taken to address variation in elective and cancer performance and provide evidence of the impact this has had on patient waiting lists. 12 The NHS’s recovery cannot succeed without comprehensive, realistic and sustainable plans for the future of the workforce and the capacity of adult social care. The Royal Colleges of Radiologists, Surgeons, Nursing, Obstetricians and Gynaecologists, and Ophthalmologists all submitted evidence to us stressing the need for strategic workforce planning. In our March 2022 report on NHS backlogs, we stated that “the NHS will be less able to deal with backlogs if it does not address longstanding workforce issues”. Deferring action on this means not making the best use of the NHS’s existing hardworking and committed frontline staff. It is also clear that the success of the recovery programme is reliant on realistic long-term planning in other areas of health and care, including the capacity of adult social care where this is reducing flow through hospitals. The Department confirmed some of the steps it will take immediately, including to publish an independently verified forecast of the number of health professionals the NHS requires during 2023 and to allocate additional funds to improve hospital discharge into adult social care. These are not end-points, however, and results of this work must be incorporated into realistic planning assumptions for NHS elective and cancer recovery. Recommendations:
|