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Cancer waiting times for NHS patients are at their worst recorded level and elective care targets are repeatedly not being met, according to a new report by the Public Accounts Committee (PAC).
The report examined targets made by NHS England in its recovery plan, published in February 2022, which were designed to recover elective and cancer care services to pre–pandemic levels by 2025.
However, even before the pandemic, NHS England had not met its elective waiting time performance standard for four years, or its operational standards for cancer care in six years. This means that even if all targets were met, the NHS would still be operating below its legal and operational standards for cancer and elective care.
Now, MPs have revealed that the backlog in cancer and elective care is not being dealt with quickly enough and in some cases is getting worse. They are now calling on NHS England and the Department of Health and Social Care to urgently bring these care services back to an acceptable standard.
How much progress has the NHS made?
The report highlights six key issues with how well the NHS is recovering its services. It also offers recommendations for NHSE and the Department on how to overcome these obstacles and reduce waiting times for services.
1. “Worrying” waits for cancer treatment
When NHSE first published its recovery plan, it aimed to recover the weekly count of patients waiting over 62 days to pre-pandemic levels by March 2023. This target has not been achieved.
In fact, in the first five months following the plan’s publication, only 62% of cancer patients were treated within two months of an urgent referral; the target is 85%. Concerningly, around one in 10 (11%) patients had to wait for 104 days or more to start treatment following a referral.
MPs say that these missed targets mean that more patients are “suffering the inacceptable consequences of waiting too long.”
2. NHSE over-promised and under-delivered
The recovery plan made a significant error in assuming that there would be low levels of Covid-19 and minimal winter pressures in 2022.
This caused the NHS to over–promise on targets, which were unachievable given the major pressures the health service has been under. This includes the 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.
MPs say NHSE and the Department now need to revisit and publish their planning assumptions for the recovery of the NHS so that patients and staff can see a “clear and realistic trajectory” to achieve reductions in waiting times for services.
3. Funding is not been spent effectively
Despite the government allocating £14 billion to NHS England to recover these services, MPs say the health service “has a problem with reduced productivity”, with an internal review finding that the NHS was around 16% less productive in 2021 compared to 2019.
Since NHSE chose not to provide a costed version of its recovery plan, there is a risk that the future allocation of resources will not be informed by the reality on the ground, MPs say.
The PAC report urges NHSE to transparently describe how the additional funds for elective recovery have been allocated and provide details of the programmes on which it expects the £14 billion to be spent.
4. Concern that community diagnostic centres and surgical hubs are not having a ‘real-world impact’
As part of plans to improve capacity, the NHS set up new diagnostic centres and surgical hubs, and said it would better utilise the public sector.
However, MPs are concerned about how the NHS plans to staff these new hubs without detracting from other NHS services.
Currently, they add, there is limited evidence to support their effectiveness and how they impact on other parts of the health and social care system.
The report therefore urges the health service to fully describe the real-world impact of community diagnostic centres and surgical hubs, as well as how these initiatives have generated genuine additional activity, rather than simply displacing activity elsewhere in the NHS.
5. Significant variations in quality of care across geographical areas
In 2022, NHSE pledged to reduce disparities in the quality of care across geographical regions by sharing best practice between areas and supporting and challenging leaders.
MPs say that 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.
They therefore suggest that the NHS “lifts its sights” and refocuses on its strategic duty to offer direction to the whole NHS. This includes addressing historical inequalities between areas and having a clear set of actions to improve leadership.
To hold NHS leaders accountable, MPs have requested NHSE to write to them explaining what action they have taken to address the variation in elective and cancer performance across regions.
6. Workforce issues and a lack of social care capacity are slowing progress
Despite the NHS grappling with more than 133,000 staff vacancies, the government has failed to publish a detailed workforce plan.
Deferring this action, MPs say, makes it significantly more difficult for the NHS to deal with backlogs, and does not make the best use of the NHS’s existing staff.
A lack of capacity in adult social care is also reducing flow through hospitals, leaving thousands of patients stuck in hospital when they are medically fit to be discharged.
MPs now want to see the Department and NHSE urgently publish its workforce plan and planned improvements in adult social care, and write to them reassessing the achievability of elective and cancer recovery targets following this publication.
Spring statement must deliver adequate funding for NHS
The NHS Confederation say that despite the significant challenges the NHS is facing, the health service is making progress.
Matthew Taylor chief executive of the NHS Confederation said: “NHS leaders are doing all they can to keep patient appointments on track in the face of a continuing wave of industrial action and there are signs that winter pressures are reducing, with cases of flu and A&E admissions going down. Also, thanks to the incredible work of healthcare staff, ambulance response times, hospital handover delays and diagnostic waits are all improving despite huge gaps in the workforce.
“There is no denying that the NHS is going through an extremely tough period and it is in the government’s hands to set out details on its long overdue workforce plan, to reach level ground with the trade unions, and ensure that its Spring Statement delivers both for the NHS and the communities it serves.”