The Public Accounts Committee has found that despite spending £3.24 billion on transforming diagnostic and surgical services, NHS England has missed its recovery targets.
NHS England (NHSE) has failed to meet its post-COVID recovery goals to shorten patient waiting lists. The Public Accounts Committee (PAC) has found that despite NHSE spending £3.24 billion on transforming diagnostic and surgical services, it has now missed its recovery targets by significant margins, with too many people still waiting too long for tests and treatment.
The PAC’s report finds that these failures were driven in part by NHSE’s and the government’s flawed approach to improving its own services. Billions of pounds in spending were approved by the government without sufficient focus on what exactly its funding would deliver and without any focus on outcomes for patients.
Diagnostic transformation received the lion’s share of £2.2 billion, and £1.04 billion went to surgical transformation, at a time of scarcity for capital funding. A shortfall of 3.6 million tests led to the missed diagnostics target; for new surgical hubs, only the number of newly delivered hubs was tracked, with NHSE unable to say what contribution they actually made to total elective activity.
“Every unnecessary day that a patient spends on an NHS waiting list is both one of increased anxiety for that person’s unresolved case, and if they are undiagnosed, a steady increase of risk to their life,” said the PAC’s deputy chair Clive Betts.
Change the money flows
In January, more than six million people were waiting for elective care, and progress in reducing waiting times appears to have stalled. Nearly 192,000 patients were waiting more than a year for care by July – a length of wait which should have been eliminated by March. And for diagnostic tests, 22% of patients were on a waiting list for more than six weeks – against a target of 5% by March, and an operational standard of 1%.
The report recommends that NHSE and the government should focus reporting on patient outcomes to ensure that funding delivers its intended outcomes, set out plans to reach the 1% operational standard for six-week waits for diagnostic tests, and learn the lessons from the failure of the outpatients programme.
Responding to the report, Kat James, managing director of Consultant Connect, an advice and guidance provider to the NHS, recommended that the government take a step back and redesign the system if it is going to have any impact.
“The fire in this scenario is waiting lists. Everyone wants to see more patients and is trying to find extra staff to put on extra clinics. But what we need is to take time out to analyse pathways and figure out where things need to be set up differently to stop the waiting lists from growing out of control in the first place,” she said, also calling the criticism of community diagnostic centres “particularly apt”.
“The solution is to change the money flows to incentivise Trusts to work closer with local communities and diagnostic centres. There’s been a lot of stick so far in terms of targets, but we need the carrot if we’re going to accelerate change,” she said.
