A £14bn plan to reduce NHS backlogs caused by Covid is failing to meet targets, with cancer waiting times at their worst-ever levels, parliament’s spending watchdog has said.
A report by the Commons’ public accounts committee said NHS England’s three-year recovery programme for elective and cancer care, agreed in 2022, was already “falling short” in its first year and expressed serious doubts that the wider plan would be achieved on time.
MPs found that although the first target was to eliminate two-year waits for elective care by July 2022, there were 2,600 patients who had been waiting more than two years in August 2022, and a record 7 million people on waiting lists in total.
The recovery programme was overoptimistic, the report said. “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 MPs found waiting times for cancer treatment were “at their worst recorded level”, and concluded that the target to ensure that 85% of people did not wait more than 62 days for cancer treatment after an urgent GP referral would not be met by March 2023. In the first five months of 2022-23, only 62% of patients met the target and 11% were treated more than 104 days after an urgent referral.
NHS England was allocated £14bn of recovery funding in September 2021 for the three years from April 2022, and published its recovery plan in February 2022.
Meg Hillier, Labour chair of the public accounts committee, said that, despite a significant cash injection 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,” she said. “That is simply shameful, and totally unacceptable in a nation as wealthy as ours.”
NHS England has committed to publishing an NHS workforce plan by April 2023. But the PAC’s report also criticised the “dearth” of advance planning to ensure enough staff and capacity for extra diagnostic tests and treatments – much of which was “already needed before the Covid-19 pandemic”.
“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,” said Hiller.
“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.”
Responding to the findings, Matthew Taylor, chief executive of the NHS Confederation, said the NHS was paying the price for the longest financial squeeze in its history, and that a decade of austerity had left it to grapple with 133,000 staff vacancies, a shortage of key equipment, and much of the estate in ill-repair.
“All of this, alongside the pandemic, [has] contributed to lengthening waiting lists but the NHS is working hard to reduce these, having already virtually eliminated the two-year elective care backlog.
“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.”
Sir James Mackey, national director of elective recovery at NHS England, said there were “a number of factual errors” in the PAC’s report.
“Even though there have been much higher levels of Covid [than agreed assumptions], NHS staff hit the first milestone, virtually eliminating two-year waits, and have made significant progress on the second by cutting the number of 18-month waits by over a quarter in the last month – facts that have been ignored in this release,” he said.
“On cancer, thanks to the efforts of the NHS, record numbers are coming forward for checks, allowing staff to do the clinically correct thing by prioritising the most urgent cases – the health service cannot help those who do not come forward.”
In Wales, barely half (54%) of patients start treatment for cancer within 62 days of an urgent referral by their GP, while in Scotland, the SNP government is also failing to meet its cancer targets, with no Scottish health boards meeting the target to treat 95% of patients within 62 days of an urgent referral by GPs. Overall just under three-quarters (74.7%) of patients began treatment within the 62-day standard, according to the latest figures.
Wes Streeting, shadow health secretary, said the NHS was in the biggest crisis in its history, and things were still not improving. “Until the Conservatives admit they have failed to train enough staff, the NHS will continue to struggle to treat patients on time,” he said.
“In the budget, the government must adopt Labour’s plan to double medical school places and train 10,000 more nurses every year, paid for by abolishing non-doms.”
