MPs have warned the first year of NHS England’s three-year recovery programme is already falling short of expectations, that targets are likely to be missed and that they want a better explanation of greater use of private hospitals.
The Public Accounts Committee (PAC) is highly critical of recovery plans from the Department of Health and Social Care (DHSC) and NHS England, believing there were “serious doubts” about some targets and that others were “unachievable”.
It recommended the bodies revisit their planning assumptions for NHS recovery and publicly report updates to targets.
The committee also told the bodies to better explain the “real-world” impact of community diagnostic centres, surgical hubs and increased use of the independent sector.
It particularly urged the DHSC and NHS England (NHSE) to do “whatever is required” to bring cancer treatment back to an acceptable standard.
Record cancer waits
In its latest report the PAC highlighted record waits for cancer care with the proportion of people receiving timely cancer treatment actually decreasing.
Cancer waiting times are at their “worst recorded” level and NHS England will not meet its first cancer recovery target, the committee added.
It concluded the target to reduce the number of people waiting overlong for urgent referral will not be met and the target for recovering elective care is “unachievable”.
While 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 seven million people on waiting lists in total.
This latter figure has since risen to 7.2 million at the end of December.
The MPs found 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 expressed “serious” doubts that the wider NHS recovery plan would be achieved to time.
It further highlighted that 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 pandemic.
After years of appeals from the sector, in November the government finally committed to publishing an NHS workforce plan, including independently verified forecasts for the number of doctors, nurses and other professionals needed to maintain the workforce over the next five to fifteen years.
Consequently the Committee called on NHS England to immediately act 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.
But it added this will require clarity and reality about how long that will take to achieve through domestic training.
Cancer wait times
The report found cancer waiting times were at their worst recorded level and concluded NHS England will not meet its first cancer recovery target.
While 85% of people who have been urgently referred by their GP and have cancer confirmed should start treatment within 62 days, 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 the committee at the end of November, NHSE acknowledged that this first cancer recovery target would be missed.
Consequently, the committee said 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 added that as a “matter of urgency”, the DHSC and NHS England should “do whatever is required” to bring cancer treatment back to an acceptable standard.
Over-optimism about resilience of NHS
The report also found NHS England was “over-optimistic” about the circumstances in which the NHS would be trying to recover elective and cancer care.
In the committee’s first report on NHS backlogs and waiting times in March 2022, it reported 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”.
But the committee found the recovery plan continued this over-optimism.
It included 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 committee said 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 the committee 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 with “powerful” examples of the uncertainty, anxiety and other problems experienced by long-waiting patients.
Here the MPs called on DHSC and NHSE to revisit their planning assumptions for the recovery and publicly report any updates to targets so 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.
Real world impact independent sector
NHS England’s elective recovery programme partly relies on initiatives which have potential but for which there is so far “limited evidence” of effectiveness, the committee said,
The report found that while NHSE had expanded some programmes because it believed them to be sufficiently promising, there was 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 said it would ensure that capacity in surgical hubs, community diagnostic centres and the independent sector would be genuinely additional.
However, the committee warned it had more work to do to demonstrate how additional capacity will be sufficiently staffed without detracting from other NHS services.
The committee also raised concerns that NHSE could not provide the National Audit Office with its full evaluation of the 2021 elective accelerators programme, on which it spent £160m.
It concluded that 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 has been told to write to the committee 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.
NHSE should also 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.
Collective effort needed
Commenting on the findings of the report, Independent Healthcare Providers Network (IHPN) chief executive David Hare said the sector had a key role to play in delivering the recovery plan.
“This report highlights the scale of the issues which the health service still faces, and the precarious nature of the recovery efforts,” Hare said.
“The recovery plan has always been bold and ambitious. To deliver it, or even get close, we need every part of the health service to be harnessed as part of a shared collective effort. This includes the independent sector.
“Our members believe there is more they can do to support this effort, and they are ready and willing.
“We must be leaving no stone unturned to ensure every person on the waiting list can be seen and treated as quickly as possible.
This includes ensuring every NHS patient is aware of their legal right to choose the best provider for them, including in the independent sector.“