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Government has overseen “years of decline” in cancer and elective care, say MPs

BMJ 2022; 376 doi: https://doi.org/10.1136/bmj.o682 (Published 16 March 2022) Cite this as: BMJ 2022;376:o682
  1. Gareth Iacobucci
  1. The BMJ

The Department of Health and Social Care for England has presided over a sustained decline in the NHS’s performance on cancer and elective care that began long before the covid-19 pandemic, a damning report from MPs has concluded.

The House of Commons Public Accounts Committee said in a report published on 16 March that the department had failed to sufficiently increase capacity to meet growing demand, causing waiting times to spiral.1 “On top of these previous failures and despite the heroic efforts of the NHS workforce, the covid-19 pandemic has inevitably caused a further huge deterioration in the NHS’s provision of elective and cancer care,” the report said.

Ever since February 2016 the NHS has not met its target to see 92% of people on the elective care waiting list within 18 weeks. It has also failed to meet the eight key targets for cancer care in totality since 2014. In December 2021 only 67% of patients with a GP’s urgent referral for suspected cancer began treatment within 62 days, against the target of 85%.

By the end December 2021 a total of 6.07 million patients were waiting for elective treatment such as hip or knee replacements or cataract surgery, the largest waiting list since records began. Of these, only 64% (3.87 million) have been waiting less than 18 weeks, and 311 000 have now been waiting for more than a year. Even before the pandemic only 83% were being seen within 18 weeks, the report said.

The committee also noted that there were between 7.6 million and 9.1 million missing referrals of patients for elective care and between 240 000 and 740 000 missing urgent referrals for suspected cancer as of September 2021, as a result of patients not presenting or being unable to access NHS services during the pandemic. Many patients have faced serious health consequences from the delays, the MPs said.

The government has pledged an additional £8bn for elective care recovery and £5.9bn for capital expenses between 2022-23 and 2024-25 and has said that it expects this funding to enable elective care activity to be 30% higher than before the pandemic.

But neither the health department nor NHS England and Improvement has set out “in meaningful detail” how the money will be spent on improving waiting times, and the department urgently needs to improve its record of holding the NHS to account, the MPs said.

The committee’s chair, Meg Hillier, said, “We on PAC are now extremely concerned that there is no real plan to turn a large cash injection into better outcomes for people waiting for lifesaving or quality-of-life-improving treatment. Nor is it obvious that the department finally understands that its biggest problem, and the only solution to all its problems, is the way it manages its greatest resource: our heroic NHS staff.

“The cycle of glib headlines and fiddling with management structures must be broken, with an overhauled ‘people plan’ that gets to the core of the desperate understaffing and under-resourcing that have undermined our health system.”

The report concluded, “Any transparent and realistic assessment of what the Department and NHSE&I expect elective and cancer care services to achieve by 2024-25 needs to include an assessment of the number of staff that will be available, how staff who have been working under intense and consistent pressure will be supported, and how patients will be kept informed about their own progress through waiting lists.”

Saffron Cordery, deputy chief executive of NHS Providers said, “The government must set out the concrete action it will take to tackle the 110 000 staff vacancies and provide a sustainable workload for the workforce. These staffing gaps are putting significant pressure on quality of care and patient safety.”

A Department of Health and Social Care spokesperson said, “We have set out our action plan to deal with the covid backlog and deliver long term recovery and reform, backed by a record multibillion pound investment over the next three years, and our 10 Year Plan on cancer.

“We are clear that business as usual is not enough. That’s why we are delivering brand new surgical hubs and another 100 community diagnostic centres providing an extra nine million scans, checks, and procedures by 2025 to make sure patients get the surgery they need and earlier access to tests, including for cancer.”

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