Public Accounts Committee 12 June 2019
- The PAC report highlights waiting time standards, the DHSC review of waiting times, the impact for patients of longer waits, bottlenecks in hospital capacity, factors which could affect plans to better manage elective care.
The PAC findings:
1. The NHS is failing to meet key waiting times standards for cancer and elective care, and its performance continues to decline.
Recommendation: NHS England should set out, by December 2019, how, and by when, it will ensure that waiting times standards for elective and cancer care will be delivered again.
1. The NHS is failing to meet key waiting times standards for cancer and elective care, and its performance continues to decline.
Recommendation: NHS England should set out, by December 2019, how, and by when, it will ensure that waiting times standards for elective and cancer care will be delivered again.
2. The Department of Health & Social Care has allowed NHS England to be selective about which standards it focuses on, reducing accountability
Recommendation: The Department of Health & Social Care and NHS England should clarify to the Committee by December 2019:
• how NHS England will be held accountable for achieving waiting times standards now and in the future; and
• what additional support NHS England and NHS Improvement will put in place to help local NHS bodies to meet waiting times standards.
Recommendation: The Department of Health & Social Care and NHS England should clarify to the Committee by December 2019:
• how NHS England will be held accountable for achieving waiting times standards now and in the future; and
• what additional support NHS England and NHS Improvement will put in place to help local NHS bodies to meet waiting times standards.
3. We are concerned that NHS England’s review of waiting times will not be enough to ensure a clear understanding of, and strong accountability over, the performance of the NHS.
Recommendation: The Department of Health & Social Care should ensure that any changes to current waiting times standards:
• help to improve patient outcomes and patient experiences;
• do not water down current standards to make them easier to meet; and
• are communicated clearly to the public, so that patients understand what they can expect of the NHS.
Recommendation: The Department of Health & Social Care should ensure that any changes to current waiting times standards:
• help to improve patient outcomes and patient experiences;
• do not water down current standards to make them easier to meet; and
• are communicated clearly to the public, so that patients understand what they can expect of the NHS.
4. The national health bodies lack curiosity about the impact for patients of longer waits and how often this leads to patient harm.
Recommendation: The Department of Health & Social Care, together with NHS England and NHS Improvement, should write to us by December 2019 on how they are going to ensure that the data on patient harm due to long waiting times are going to be routinely collected, reported and acted upon.
Recommendation: The Department of Health & Social Care, together with NHS England and NHS Improvement, should write to us by December 2019 on how they are going to ensure that the data on patient harm due to long waiting times are going to be routinely collected, reported and acted upon.
5. Bottlenecks in hospital capacity are having a detrimental impact on how long patients wait for treatment.
Recommendation: NHS England and NHS Improvement should evaluate and report back to the Committee on how the NHS plans to ensure that it has the required diagnostic and bed capacity to meet patient demand in the medium to long term. They should also set out, in the short term, how they will support local bodies to improve their patient flow through the health system and reduce unwarranted variation
Recommendation: NHS England and NHS Improvement should evaluate and report back to the Committee on how the NHS plans to ensure that it has the required diagnostic and bed capacity to meet patient demand in the medium to long term. They should also set out, in the short term, how they will support local bodies to improve their patient flow through the health system and reduce unwarranted variation
6. The NHS still does not understand sufficiently what is driving demand for referrals for elective treatment.
Recommendation: As we recommended in March 2019, NHS England and NHS Improvement should, by September 2019, write to us to set out how they will help local bodies to better understand the demand for care, and to plan their services accordingly to better meet the needs of their local patients
Recommendation: As we recommended in March 2019, NHS England and NHS Improvement should, by September 2019, write to us to set out how they will help local bodies to better understand the demand for care, and to plan their services accordingly to better meet the needs of their local patients
7. NHS England has not yet identified how it will manage the variety of factors that could affect the success of its plans to better manage elective care.
Recommendation: The Department, NHS Improvement and NHS England should, by December 2019, clarify to us: • How they are going to develop a fit-for-purpose workforce to ensure that the ambition to reduce face-to-face appointment by one-third is going to be achieved. • How they are going to ensure access to care is maintained if the number of outpatient appointments is not reduced as planned.
Summary
Recommendation: The Department, NHS Improvement and NHS England should, by December 2019, clarify to us: • How they are going to develop a fit-for-purpose workforce to ensure that the ambition to reduce face-to-face appointment by one-third is going to be achieved. • How they are going to ensure access to care is maintained if the number of outpatient appointments is not reduced as planned.
Summary
The NHS treats more and more people each year, and patients have a right to expect to receive treatment within the timescales set out by the NHS Constitution. But more and more patients are being let down by the NHS’s continued failure to meet deadlines for waiting times. The percentage of patients treated within waiting times standards continues to get worse for both elective (non-urgent care) and cancer treatment. It is unacceptable that less than half of NHS trusts and foundation trusts (trusts) meet the 18-week waiting times standard for elective treatment, and only 38% meet the 62-day standard from referral to treatment for cancer patients.
Like many areas within the NHS, demand for elective and cancer treatments is growing which risks exacerbating this worsening performance. The waiting list for elective care has grown by one and a half million since March 2013 to 4.2 million in November 2018. NHS organisations are not being sufficiently held to account for ensuring patients’ rights to treatment within maximum waiting times for elective care. The NHS does not yet fully understand what is driving the demand for elective care, undermining its ability to plan services to meet patient needs. We are also concerned that the national bodies responsible for setting and managing waiting times appear to lack curiosity regarding the impact of longer waiting times on patient outcomes and on patient harm. Improvement is clearly needed to ensure patients get the treatment they need within the waiting times standards the government has set. The long-term term funding settlement for the NHS, the NHS Long Term Plan, and the current review of waiting times standards present an opportunity to get the NHS back on track in meeting waiting times standards.
