Senior doctors are being forced to complete time-consuming training courses "that an 8-year-old could do" while patients are "bearing the brunt" of NHS strikes, MPs have been told.
NHS leaders were asked why consultants are "wasting time" completing mandatory training courses instead of seeing patients.
It comes as officials suggested the record backlog of care in the health service will not reduce as planned due to industrial action.
One of the Prime Minister's key objectives is to cut the NHS's waiting list, which stands at 7.77 million.
NHS England Chief Executive Faced Questioning by MPs
Amanda Pritchard, NHS England chief executive, told the Health and Social Care Committee that without industrial action the waiting list was expected to be falling by the end of this financial year. She said: "In reality, we've had now over a million patient appointments rescheduled as a consequence of industrial action.
"What we have now done as a consequence – not just of the impact on activity but also the financial impact of industrial action – is agreed with Government that we have lowered the activity expectations for elective activity this year… the overall level of activity that we're now able to do clearly does put that overall waiting list challenge in perspective."
Strikes have cost the NHS more than £1 billion, and a large proportion of money to plug the gap is being funded by technology and building budgets and the Department of Health and Social Care.
Ms Pritchard said she would "have preferred not to have to reprioritise any funding" but it was for the Government to make the call given other demands on the public purse. She added: "It is patients that are bearing the brunt of this."
Ms Pritchard said she met England's new Health and Social Care Secretary Victoria Atkins on Monday and discussed strikes in the service as well as winter preparedness.
Some Training Courses "A Waste of Consultants' Time"
Meanwhile, NHS bosses were challenged over mandatory training courses in the health service. Dr Caroline Johnson, a consultant paediatrician and MP for Sleaford and North Hykeham, said: "I have to do 29 mandatory training programmes, some of which I have to redo every single year.
"I read them to my eight-year-old and he could answer them.
"We will be asked things like, 'What must you do if you receive a phishing email? Choose the correct option: reply, open the attachments, forward it to your colleagues or follow your organisation's procedures?'
"Another question we have received: 'It is important to lock your computer or mobile device when you're not using it, true or false?'
"There are consultants doing these training programmes.
"(We are shown) pictures of two defibrillator pads on a gentleman's abdomen (and asked): 'Is this the correct position to put defibrillator pads?'
"Why are we wasting consultants' time with this nonsense?"
"For example, fire lectures on the face of it make a lot of common sense. If it was teaching me how to evacuate patients in a fire, how to keep children's safeguarding levels high in such a situation, or how to manage the oxygenated patient, maybe it'd be useful.
"But I have on several occasions sat through videos which have included a bonfire in a field and someone watching what happens when petrol is poured on to it – not a good thing to do but not at all useful to anyone working in a hospital."
Dr Johnson added: "I remember watching that video of the bonfire with petrol being poured on it by a couple of young lads in the field for the second time and looking around at the lecture theatre with perhaps 100 people in it, certainly more than 80 people in it, and thinking, 'The NHS keeps saying it's short on money, and it's short of workforce, and we are all sat in a room wasting our time while we could be seeing patients."
Training Justified for Safeguarding and Cybersecurity
Professor Sir Stephen Powis, NHS England's medical director, said: "I'm going to push back a little because I think there's a balance here to be struck. So, I think there is a need for members of staff – and of course, it's not just the consultant workforce or doctor or medical workforce – to be aware of many of the issues that are covered in mandatory, and safeguarding is one, (as is) cybersecurity.
"We can discuss the quality of the questions and how it is delivered but I don't think anybody around the Committee today would disagree that cybersecurity is one of the greatest risks that we face within the NHS and of course, wider public bodies, so ensuring that staff are aware of some of the risks around cybersecurity, I think, is perfectly legitimate.
"And I think it is correct that that is part of mandatory training.
"I don't think any of you would argue that it's not right that people should understand safeguarding and some of the legislation behind safeguarding.
"I think it's about ensuring that the mandatory training that is delivered is the correct mandatory training, it is done in the best possible way and the most effective way. I think it's about getting the balance right."
Meanwhile both Sir Stephen and Ms Pritchard both reiterated their support for the training of NHS managers in the wake of the Lucy Letby case.
In August, Letby was sentenced to a whole life order after being convicted of murdering seven babies and trying to murder six others on the Countess of Chester Hospital's neonatal unit in 2015 and 2016.
"Whilst it is very complex – it would require legislation ultimately, of course, it is a matter for Government – actually, it is the right time for us to look again at whether there is value in a more formalised regulatory approach," Ms Pritchard said.