Plan to cut NHS England elective care backlog at serious risk, watchdog says

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Millions of patients could face years of long waits for treatment on the NHS, as a watchdog warned that the plan to reduce extensive waits for elective and cancer care services by 2025 is at serious risk.

NHS England published a three-year plan in February aimed at tackling the backlog in services, after the Covid-19 pandemic saw already long waiting lists grow to record levels. The Department of Health and Social Care is responsible for funding the recovery plan.

However, the cash that ministers originally allocated for the plan has not kept pace with inflation, and the NHS faces “significant” workforce and productivity issues, the National AuditOffice (NAO) said.

In addition, the watchdog warned that a reliance on overstretched GPs to absorb some of the work traditionally done in hospitals was likely to result in key aims not being met, leaving desperate patients – some of whom have waited years for treatment – in the lurch.

“Health leaders agree that the NHS’s ability to clear the elective backlog is under severe threat unless the government acts quickly,” said Matthew Taylor, the chief executive of the NHS Confederation, which represents the healthcare system in England, Wales, and Northern Ireland.

Dr Emma Runswick, deputy chair of council at the British Medical Association, which represents about 150,000 doctors, said: “It’s absolutely essential that the funding government allocated for tackling the backlog and growing waiting lists from Covid-19 is urgently reviewed. It’s only right that this funding increases in line with inflation, otherwise the recovery plan simply won’t work.”

NHS England’s plan assumed that services would recover to pre-pandemic levels of activity early in 2022-23, with an aim of about 30% more treatments by 2024-25. However, the NAO said increasing activity to these levels would be a “historic feat”, adding that it would “require a rate of growth not seen in recent times”.

The NHS is now 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 NAO said.

However, the watchdog said it was concerned that GPs were already under pressure, with the GP workforce having decreased by 4% between June 2017 and June 2022.

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

NHS England set a target for a minimum 25% reduction in outpatient follow-up appointments by March 2023, but the NAO said it had heard from medics 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”.

The NAO said NHS England intended that elective care waits of more than one year should be eliminated by March 2025, and that by March 2023 the number of patients waiting for cancer care more than 62 days after an urgent referral should return to pre-pandemic levels. However, the watchdog said people could still be facing long waits even if progress is made.

Under the NHS Constitution for England, 92% of patients on a waiting list should start treatment within 18 weeks of referral, but that target was met in just 61% of cases in August.

Gareth Davies, the 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 spokesperson 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.”