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NHS Cancer Recovery Programme 'Already Falling Short of Expectations'

"The NHS is in full blown crisis and all the metrics are going in the wrong direction," said Dame Meg Hillier MP, chair of the House of Commons Public Accounts Committee (PAC), on the publication today of the PAC’s report on NHS backlogs and waiting times in England.

The report showed that NHS England (NHSE)’s 3-year recovery programme was "already falling short of expectations" in its first year, and described its elective care target as "unachievable". NHSE said in response that the PAC had failed to acknowledge "the significant progress made".

The report noted that despite NHS trusts being urged in July 2022 to make cancer care "a critical priority", NHSE had admitted in November that it would miss its first cancer recovery target. 

In the first 5 months of 2022-23, only 62% of patients met the 62-day target for starting treatment after urgent GP referral and cancer confirmation, as against the aim of 85%, and 11% of patients (8100 people) had to wait more than 104 days after an urgent referral. "The proportion of people receiving timely cancer treatment has actually decreased," the report said, and "cancer waiting times are at their worst recorded level".

'Shameful' That Health Indicators are Going Backwards

Dame Meg, Labour (Co-op) MP for Hackney South and Shoreditch, said that NHS England "must lift its sights". She noted that "despite a significant cash injection" to aid recovery from pandemic measure backlogs, on the evidence received by the PAC, the NHS would fail to achieve its targets. "That means health, longevity and quality of life indicators will continue to go backwards for the people of this country. That is simply shameful, and totally unacceptable in a nation as wealthy as ours."

The report also noted that although the first target had been to eliminate 2-year waits for elective care by July 2022, by August last year there remained 2600 patients who had been waiting more than 2 years – against a 'legal standard' of 18 weeks – with a record 7 million people on waiting lists in total. The target for recovering elective care was over-optimistic, would not be met, and was in fact "unachievable", it said.

It accused NHS England of making "unrealistic assumptions" and said it was "still not planning properly for the staffing and other resources it needs to deliver additional diagnostic and treatment capacity". Furthermore, there was "limited evidence" for the effectiveness of some initiatives within NHSE's elective recovery programme, and NHSE had not produced a detailed costed version of the plan to show how it intended to allocate its additional £14 billion.

NHS 'Has a Problem with Reduced Productivity'

Moreover, it was "concerning" that NHSE could not provide the National Audit Office with a full evaluation of monies spent so far. NHSE needed to describe the "real-world impact" of community diagnostic centres, surgical hubs, increased use of the independent sector, and its advice and guidance programme, and "should set out its understanding of the extent to which these initiatives have so far generated genuinely additional activity, rather than simply displacing activity elsewhere in the NHS".

The PAC added that: "Overall, the NHS has a problem with reduced productivity". Its own internal review had estimated that it was around 16% less productive in 2021 than in 2019 – and not only due to immediate pandemic effects.

The Committee had "serious doubts" that the wider NHS recovery plan would be achieved to time. NHSE should act now on the two areas that most obviously need new, effective planning – increasing the capacity of adult social care so that flow through hospitals improves, and getting in place the long overdue strategy to create a productive healthcare workforce of the right size. Dame Meg said that the NHS "must now step up and show that leadership for a realistic way forward, with targets that have patients seeing the real improvements".

However, in a statement, NHSE countered that it was "not accountable for social care", and that it had committed to publishing by April this year the workforce plan promised by the Government in its November Autumn Statement. The PAC had also said, that NHSE must "refocus on its strategic duty to offer direction to the whole NHS”, including the need "to rebuild a crumbling physical estate that is in dangerous condition in many places". However NHSE said it was "not responsible for funding of the NHS' estate".

NHSE: Committee 'Ignored Facts'

Sir James Mackey, NHSE's national director of elective recovery, said that the PAC's release accompanying its report included "a number of factual errors" and failed to acknowledge "the significant progress made by NHS staff on the elective recovery plan despite record pressures seen across the health and care system".

He added: "The milestones set out in the plan, published just over a year ago, were based on widely shared and agreed assumptions about low prevalence of COVID.

"Even though there have been much higher levels of COVID, NHS staff hit the first milestone, virtually eliminating 2-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.

"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."

Commenting on the report to Medscape News UK, Minesh Patel, head of policy at Macmillan Cancer Support, said: "Today's report is deeply worrying and highlights yet again the worry and anguish for so many cancer patients. With cancer waiting times plummeting to the worst on record and a chronic shortage of cancer professionals, the current cancer care system simply isn't fit for purpose. 

"It is vital that the UK Government comes good on its promise to reduce waiting lists once and for all. To do this it must invest in growing and supporting the NHS cancer workforce and putin place an urgent support package for cancer services. People living with cancer cannot – and should not – wait any longer."