Over-optimistic assumptions leave recovery programme off target

While individual programmes to recover elective and cancer waiting times are aiming for ‘sensible and necessary improvements,’ the overall strategy lacks detail on how these will fit together to create additional capacity and how much it will cost, the PAC said in a report – Managing NHS backlogs and waiting times in England - issued this week.

It points out that in the first five months of the recovery programme, performance on cancer waiting times to treatment deteriorated. And NHS England has now admitted that the target of meeting pre-pandemic performance on patients waiting more than 62 days by this month will be missed. The PAC also expressed serious doubts over whether the target to carry out 129% of 2019/20 elective activity and to eliminate year long waits by March 2025 will be met.

It is highly critical of NHS England, saying there appears to have been a ‘dearth of advance planning to ensure the NHS has the staffing and other resources it needs to deliver additional diagnostic and treatment capacity’, much of which was already needed before the pandemic.

‘NHS England’s approach is too often to react to these problems as and when they arise, as opposed to making realistic assessments and strategic plans,’ it added. NHS England had admitted assumptions about low levels of Covid had been ‘completely wrong’ and the NHS had seen higher than expected demand for hospital beds and also high staff sickness, the report said.

However, the success of the recovery programme – which started in April 2022 - needed better flow of patients through hospital, dependent on social care, and a strategic approach to creating a productive ‘right sized’ workforce, it concluded..

PAC chair Meg Hillier (pictured) said: that, despite a significant cash injection intended to help the recovery from the pandemic, the NHS was 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,’ she said.

‘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,’ she added. ‘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.’

The committee recommended:

• The Department of Health and Social Care and NHS England should do ‘whatever is required to bring cancer treatment back to an acceptable standard.’
• NHS England and the Department should revisit the underlying assumptions in the recovery plan and report any updates to the planned trajectory for the 62-day cancer target, the 52-week wait for elective care and ultimately the 18-week standard for elective care. NHS England should also be transparent about how the additional funds for elective recovery have been allocated, how it will monitor the effectiveness of this money and how it will improve NHS productivity.
• NHS England should tell the committee about the real-world impact of community diagnostic centres, surgical hubs and increased use of the independent sector and how much they have contributed to additional activity, rather than displacing activity elsewhere. Evaluation of programmes was needed.
• NHS England should refocus on its duty to offer direction to the whole NHS, including making difficult trade-offs to address historic inequalities between areas and ‘having a clear set of actions to improve leadership.’
• The Department and NHS England should reassess the achievability of recovery targets taking into account the planned workforce plan and improvements to discharge into social care. The Department should publish the underlying assumptions for forecasts in its workforce plan.