In a new report, the Public Accounts Committee pointed out that the NHS has not met the 18-week maximum waiting time standard for elective care since February 2016; nor the eight key standards for cancer care in totality since 2014.
The Public Accounts Committee said that “on top of these previous failures and despite the heroic efforts of the NHS workforce, the COVID-19 pandemic has inevitably caused a further huge deterioration in the NHS’s provision of elective and cancer care.” At the end of December 2021, 6.07 million patients were waiting for ‘elective’ care, such as hip or knee replacements or cataract surgery, the biggest waiting list since records began.
The legal standard for elective care states that 92% of people on the waiting list should be seen within 18 weeks, but only 64% (3.87 million) of these patients have been waiting less than that, and 311,000 have now been waiting for more than a year. Even before the pandemic only 83% were being seen within 18 weeks.
Only 67% of patients with an urgent referral for suspected cancer were treated within 62 days, compared to the requirement for 85% to be treated within that time.
The Committee also noted that “a striking feature of the pandemic was that very large numbers of patients did not present at, or were unable to access, routine NHS services”. As of September 2021, there were between 7.6 million and 9.1 million missing referrals of patients for elective care and between 240,000 and 740,000 missing urgent referrals for suspected cancer. People will face serious health consequences as a result of delays in treatment, with some dying earlier and many living with pain or discomfort for longer.
The Committee said any transparent and realistic assessment of what the Department and NHSE&I expect elective and cancer care services to achieve by 2024-25 must include an “assessment of the number of staff that will be available and how staff who have been working under intense and consistent pressure will be supported”.
Dame Meg Hillier MP, Chair of the Public Accounts Committee, said: “DHSC has overseen a long-term decline in elective and critical cancer care that is dragging our National Health Service and the heroic staff down. We on PAC are now extremely concerned that there is no real plan to turn a large cash injection, for elective care and capital costs of dangerously crumbling facilities, into better outcomes for people waiting for life-saving or quality-of-life improvng treatment. Nor is it obvious that the Department finally understands that it’s biggest problem, and the only solution to all its problems, is the way it manages its greatest resource: our heroic NHS staff. Exhausted and demoralised, they’ve emerged from two hellish years only to face longer and longer lists of sicker people, and this is compounded by staffing shortages in a number of professional areas.
"The cycle of glib headlines and fiddling with management structures must be broken, with an overhauled 'people plan' that gets to the core of the desperate under-staffing and under-resourcing that have undermined our health system.”
Responding to the report, the deputy chief executive of NHS Providers, Saffron Cordery said: "Trust leaders will recognise the issues explored by the public accounts committee within their latest report. They understand all too well the potential risks, disruption and distress patients face from long delays for treatment which have got significantly worse following the pandemic. Trusts are focussing on reducing waiting times, and NHS staff are working hard to meet the stretching targets to recover elective and cancer waiting times, as well as to tackle wider care backlogs.
"We know from our members there are delays across all health and care which warrant similar focus and national support, including community and mental health care. It will take time to address these backlogs and we must be realistic about what we can achieve and when. Managing waiting lists is a complex process. A survey by NHS Providers found almost all NHS Trust leaders reported that patients' conditions were often more severe and complex than before the pandemic.
"Trusts will continue to prioritise those with the greatest clinical need, those waiting the longest, and seek to close the health inequalities gap. The public accounts committee is also right to highlight the biggest problem facing the NHS as it seeks to bear down on treatment delays: the lack of NHS staff.
"The government must set out the concrete action it will take to tackle the 110,000 staff vacancies and provide a sustainable workload for the workforce. These staffing gaps are putting significant pressure on quality of care and patient safety. It's vital the government commits to a robust system for long term workforce planning for the NHS."
To read the full report, click here.
