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NHS must focus on routine care to tackle growing waiting lists, says spending watchdog

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l1350 (Published 22 March 2019) Cite this as: BMJ 2019;364:l1350
  1. Ingrid Torjesen
  1. London, UK

The National Audit Office (NAO) has urged NHS England and NHS Improvement to set out by the autumn what actions they plan to take to reverse growing waiting times for elective procedures and cancer treatment.

While the number of people treated by the NHS each year is increasing, numbers of available beds have fallen, staff shortages have worsened, and the capacity of diagnostic services has not kept pace with rising demand, a report from the NAO says.1 Greater priority has also been given to emergency care and urgent cancer services at the expense of less urgent elective care.2

The elective care standard aims for 92% of patients to be seen by a consultant within 18 weeks from GP referral. The last time this was met nationally was in February 2016. A key standard for cancer care is that 85% of patients are treated within 62 days of an urgent GP referral for suspected cancer—this has not been met since the end of 2013.

Amyas Morse, head of the NAO, said that efforts to increase the number of urgent cancer referrals were “a positive step” that had helped diagnose more patients earlier, leading to better outcomes, despite meaning that waiting times commitments for cancer care were no longer being met.

But he added: “There hasn’t been enough progress on tackling the reasons behind the increasing number of patients now waiting longer for non-urgent care. With rising demand as well as constraints on capacity, it’s hard to see how the NHS will be able to turn around this position without significant investment in staffing and infrastructure.”

The waiting list for elective care grew from 2.7 million to 4.2 million between March 2013 and November 2018, while the number waiting more than 18 weeks grew from 153 000 to 528 000. Waiting times performance also varies significantly across geographical areas, providers, and specialties.

Since 2010-11, the number of NHS beds has fallen by 7% (8000), while bed occupancy rates have risen. While reducing excess beds may create efficiencies, after a certain point the capacity challenges this introduces will impact on other resources such as staff and theatre usage, the NAO warned.

It called on NHS England and NHS Improvement to clearly set out by October 2019 their objectives for waiting times and how they will tackle declining performance. “This should include putting the right incentives and support in place and clarifying how they will ensure that local bodies and partnerships have the right resources and capacities to meet their waiting times objectives.”

The two bodies should also carry out research to understand better the impact of waiting times on patients’ experience, patient outcomes, and urgent services; variations in performance against the waiting times standards across specialties and across different population groups; the impact of staff shortages by specialty on performance; and the impact of bed occupancy on delays to treatment, and its links to other variables such as staff numbers and theatre usage.

Meg Hillier, chair of the House of Commons Public Accounts Committee, said: “The link between waiting times performance for non-urgent and cancer care and strained capacity is clear. The NHS needs to identify how it will improve waiting times as a matter of urgency.”

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