NHS Confederation submission to Public Accounts Committee inquiry on reducing NHS waiting times for elective care
Whilst the NHS is treating more people than ever before, it has struggled to meet the 18-week standard for elective care standard for over a decade. The government has made the restoration of the 18-week standard for elective care its key target for delivery, pledging an additional 2 million appointments a year to achieve this. There has been some early progress, with the waiting list having been reduced for six successive months.
However, these additional appointments alone won’t restore the standard.
A number of further measures are required. These include assessing the drivers for rising demand for elective treatment, digitalising waiting-list management and continuously validating the patient tracking list, transformation of outpatient care for people who do not need hospital admission, creating elective hubs for people whose treatment involves an admission to hospital, creating centres of expertise for complex elective admitted care, focusing on the enablers of change critical to transforming care and addressing the residual backlog of patients waiting.
More fundamentally, greater investment in general practice and primary care at scale to ensure wholesale provision of advice and guidance (informed by specialists) would allow GPs to better assess the need for a referral to a specialist consultant, or alternatively to decide on a different course of treatment. This could have a transformative impact on elective care.
Key enablers required to support NHS services to tackle the backlog include investment in digital capacity, wider increased capital investment and better efficiency of the existing capital allocations process, payment mechanisms that incentivise restoring the 18-week wait and high-quality booking and rescheduling processes. Without being accompanied by change, reform and extra capital investment in particular, the government’s early promise of an additional 2 million appointments, operations and diagnostics a year – mainly provided through commissioning extra capacity from the independent sector – will only address about 15 per cent of the additional requirement.
The focus on restoring the 18-week standard is important given the size of the list and impact it can have on people being unable to work until they are treated. But it does risk obscuring the wider picture of patients waiting for care in mental health and community services, as well as risking entrenching and widening existing health inequalities through failing to assess patient need holistically.
The recent changes announced for the NHS – the abolition of NHS England, mandated 50% cuts to Integrated Care Boards (ICB) and the cuts NHS trusts need to make to corporate services present further risks. Namely, distracting NHS leaders and wider staff from being able to fully focus on restoring the 18-week waiting standard and wider service reform, and by risking the loss of critical expertise from the service – particularly in relation to digital.
