A scathing report from MPs accuses the government and NHS England of failing to improve patient outcomes and raises concerns there will repeats of poor practices in HS2 and the new hospitals programme in attempts to cut waiting lists.
The influential Public Accounts Committee (PAC) of MPs found that despite NHS England (NHSE) spending £3.24bn on transforming diagnostic and surgical services, it has now missed its recovery targets by significant margins, with too many people still waiting too long for tests and treatment.
The report attributes these failures in part to NHSE’s and the government’s “flawed” approach to improving its own services.
The committee added plans to free up more outpatient appointments could have made the most difference and recommended NHSE and government should focus reporting on patient outcomes to ensure that funding delivered its intended outcomes.
It also raised concerns that major reforms announced by the Department for Health and Social Care (DHSC) and NHSE replicating poor practices seen on the HS2 and New Hospital Programmes would lead to “wasted” effort.
Stalled progress
As of January 2025, more than six million people were waiting for elective care, and progress in reducing waiting times appears to have stalled:
- Nearly 192,000 patients were waiting over a year for care by July 2025 – when this length of wait should have been eliminated by March.
- For diagnostic tests, 22% of patients were on a waiting list for more than six weeks – where there was a target of 5% by March 2025, and an operational standard of 1%.
- When it came to treatment, just 59% of patients were treated within the statutory standard of 18 weeks, against a target of 92%.
- Plans to reduce follow-up outpatient appointments by 25% (compared to 2019-20) by March 2023 saw NHSE achieve only 0.1% fewer appointments between June 2022 and July 2023.
Flawed approach
The report attributes these failures in part to NHSE’s and the government’s “flawed” approach to improving its own services.
It added billions of pounds in spending that were approved by the government without sufficient focus on what exactly its funding would deliver and without any focus on outcomes for patients.
Diagnostic transformation received £2.2bn, and £1.04bn went to surgical transformation, while a shortfall of 3.6m tests led to the missed diagnostics target.
For new surgical hubs, only the number of newly delivered hubs was tracked, with NHSE unable to say what contribution they actually made to total elective activity.
The PAC added that plans to free up more outpatient appointments could have made the most difference as the vast majority (80%) of elective care pathways ended through an outpatient appointment; but NHSE had no credible plan to achieve this, failing to secure meaningful engagement from clinicians to do so.
Consequently, the report recommends NHSE and government should focus reporting on patient outcomes to ensure that funding delivers its intended outcomes, set out plans to reach the 1% operational standard for six week waits for diagnostic tests, and learn the lessons from the failure of the outpatients programme.
Replicating poor practices
The Committee also raised concerns that major reforms announced by DHSC and NHSE replicating poor practices seen on the HS2 and New Hospital Programmes would lead to wasted effort.
Amid structural changes being made to the healthcare system without secured funding in place to pay for the changes, or impact assessments carried out, the PAC warned these changes, especially the planned cuts to local health boards, could have a significant negative impact on patients and on the workforce through the level of uncertainty they create.
The report also sought confirmation from the DHSC that it will not announce unfunded commitments, and set out the likely costs of planned redundancies and the absorption of NHSE into DHSC.
The PAC added it is not confident the DHSC is being realistic about the immense effort needed to bring down waiting times, with digital solutions risking being treated as a ‘cure-all’.
Digital integration is a key weakness for the NHS and the report seeks DHSC and NHSE’s plans to address legacy IT.
It also said it remained sceptical that digital change can satisfactorily reach all patients as there is likely to always be a part of the population who find digital technology and tools too difficult to use.
Failure to improve outcomes
Clive Betts MP, deputy chairman of the Public Accounts Committee, said: “Every unnecessary day that a patient spends on an NHS waiting list is both one of increased anxiety for that person’s unresolved case, and if they are undiagnosed, a steady increasing of risk to their life.
“Every penny of funding spent to put the NHS back on a pre-pandemic footing must be precisely targeted, or the system itself becomes an obstacle to proper care.
“Unfortunately, our report establishes that billions have been poured into the system over the past few years without the requisite focus on making sure that money does what it was intended for – improving outcomes for patients.
“The rollout of shiny new surgical hubs and diagnostic centres will only be superficially impressive if they are not used in the most productive way.
“Alarmingly, in the government’s approach to the absorption of NHSE and 50% cuts to local health boards, we are now seeing chilling echoes of past failures on HS2 and the New Hospital Programme.
“Our committee has long established that large unfunded commitments, without plans for delivery, while good at generating headlines, can only end one way. We hope the government can provide reassurance as part of this inquiry that it can come forward with the underpinning detail that can marry its ambitions to reality.”
