NHS plan to cut treatment waits 'at risk'

The National Audit Office (NAO) says the NHS plan to cut long waits for treatment and for cancer care by 2025 is at "serious risk".

In a critical report, the NAO suggested inflationary pressures, serious problems with productivity in the health service and a reliance on GPs to absorb some work traditionally done in hospitals, could mean key aims are not met.

NHS England has put in place a recovery plan after Covid-19, with targets to bring down waiting lists, including for long waiters, and to get cancer patients seen more quickly for treatment.

But the NAO warned the funding allocated by the Government for health service recovery has not kept pace with inflation, and the NHS faces "significant" workforce and productivity issues.

NHS England's plan assumed that services would recover to pre-pandemic levels of activity early in 2022/23, with an aim of around 30% more treatments by 2024/25.

But the NAO said increasing activity to these levels would be "an historic feat", adding it would "require a rate of growth not seen in recent times".

Currently, the NHS is working at 96% of pre-pandemic levels.

To help achieve its targets, NHS England wants GPs to handle many cases previously dealt with by hospital doctors, the report said.

Instead of referring some patients to specialists, GPs manage them themselves after receiving advice and guidance from hospital doctors, who also confirm that a referral is not required.

The NAO said: "For the purpose of measuring performance, NHSE has started to count these avoided referrals as a kind of additional elective activity.

"NHS England believes that, in total, around 1.7 million outpatient first attendances can be avoided in this way in 2022/23, which is 1.1 million more than were avoided in 2019/20.

"Even after giving credit for this avoided work, the NHS will still need to deliver average annual increases in actual elective activity of nearly 7%."

Pressure on GPs

The report said one area of concern is that GPs are already under pressure, with the GP workforce having decreased by 4% between June 2017 and June 2022.

Meanwhile, new community diagnostic centres have performed 1.8 million tests between July 2021 and the start of September 2022, but would need to "carry out another 1.9 million tests to reach the diagnostic target set for March 2023".

The NAO said NHS England's desire to cut down on follow-up hospital appointments had also caused concern among some clinicians and managers.

NHS England has set a target for a minimum 25% reduction in outpatient follow-up appointments by March 2023 but only five out of 42 regional health organisations have said they would meet this target.

The NAO said it had heard from medics and managers who "stated that incentives to reduce the number of follow-up appointments could lead to increased patient harm at a time when more patients might need follow-ups due to the size of the backlog and the complexity of conditions people present with."

On the issue of productivity, the NAO has examined NHS England's own estimates.

Productivity dropping

These suggest the NHS was around 16% less productive in 2021 than it was in 2019, with reduced productivity continuing into 2022/23, which the NAO said was a "major problem".

NHS England has found that, on average, NHS workers were not carrying out as many procedures as before, with reasons including more sickness absence, less willingness to work paid or unpaid overtime and the redeployment of staff between teams.

Other issues affecting productivity include the impact of Covid-19 infection control measures on operating theatre capacity and cancellations, and a "reduced management focus by NHS trusts and NHSE on cost control and operational rigour".

Overall, the NAO said NHS England intends that, by March 2025, elective care waits of more than one year should be eliminated, and that, by March 2023, the number of patients waiting more than 62 days from an urgent referral for cancer care should return to pre-pandemic levels.

But the NAO said that even if progress is made, people could still be facing long waits.

Some 92% of patients on the waiting list should start treatment within 18 weeks of referral, but performance against this target was just 61% in August.

A Department of Health and Social Care spokeswoman said: "Tackling the Covid backlogs is our absolute priority and the NHS is making strong progress by slashing waits of 18 months by 60% in a year and virtually eliminating waits of more than two years.

"Due to the unprecedented pressures of Omicron, the NHS has treated more patients in hospital during the summer than the last two combined, adding further pressure on its elective recovery plan than anticipated.

"We are not complacent and will continue to back the NHS with record funding, record numbers of staff as well as harnessing community diagnostic centres and surgical hubs so patients can get the care they deserve, when they need it."

'Significant risks'

Gareth Davies, head of the NAO, said: "There are significant risks to the delivery of the plan to reduce long waits for elective and cancer care services by 2025.

"The NHS faces workforce shortages and inflationary pressures, and it will need to be agile in responding as the results of different initiatives in the recovery programme emerge."

An NHS spokeswoman said: "Despite concerns about what is likely to be a very challenging winter, the NHS is currently on track to deliver on its next recovery milestones - after already virtually eliminating two-year waits for care and reducing 18-month waits by almost 60% in a year.

"Staff have achieved this despite higher staff absences, more Covid patients in hospital this summer than the last two combined, reduced hospital capacity caused by social care issues discharging patients back into the community, and increased demand on urgent and emergency care services."

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