• Watchdog says cutting waiting list to March 2018 levels would cost £700m
  • Report follows NHS failing on pledge to keep list at March 2018 level in 2018-19
  • NAO praises improvements on cancer outcomes achieved by NHS this year

The NHS has made “insufficient progress” on cutting its elective waiting list, according to the government’s spending watchdog.

A National Audit Office report, published today, said it could not see how the position could be recovered without significant investment in staff and infrastructure, despite a significant push on elective waiting lists by system leaders during 2018-19.

The report said an additional one-off £700m would be required to cut the waiting list back down to the level it was at in March 2018 – a target NHS bosses originally set the system to achieve by this month in the 2018-19 planning guidance.

But there were 4.2 million cases on the list at the most recent count in January, significantly more than the 3.84 million cases in March 2018.

The report recommended NHS England and NHS Improvement should carry out a significant review by October “to better understand the impact of waiting times on patients’ experience, patients’ outcomes and urgent services”.

The NAO criticism reignited the debate about how best to balance spending priorities for the NHS’ additional £20.5bn funding between new ambitions for the service and addressing existing shortcomings.

It also comes just weeks after NHS England set out proposals in its targets review, which could result in the constitutional standard for the NHS to see 92 per cent of patients within 18 weeks being scrapped altogether.

The NHS 2018-19 planning guidance said the elective waiting list should be “no higher in March 2019 than in March 2018”.

But, as exclusively revealed by HSJ, system leaders had privately accepted they would miss the pledge by last summer, despite officially stating the plan was still deliverable.

NHS England set out an urgent plan in August involving trusts falling behind their elective targets sending patients to private and neighbouring providers to try address the problem, but the system remains way off target.

NHSE said cutting waiting lists would be a focus “as the additional funding to help deliver the NHS Long Term Plan becomes available from April”.

The NAO report, NHS waiting times for elective and cancer treatment (see attached), did, however, praise the NHS for taking “actions to increase the number of urgent cancer referrals”.

The watchdog said: “[The actions] have helped to diagnose more patients at earlier stages, leading to better outcomes, even though this has meant that waiting times commitments for cancer care are no longer being met.”

But NAO head Sir Amyas Morse added: “There has been insufficient progress on tackling or understanding the reasons behind the increasing number of patients now waiting longer for non-urgent care.

“With rising demand for care as well as constraints in capacity, it is hard to see how the NHS will be able to turn around this position without significant investment in additional staffing and infrastructure.”

NHS Providers said the £700m figure was in line with its estimates of how much it would cost to drag the waiting list position back in line.

NHS Providers policy advisor David Williams told HSJ: “This figure [£700m] seems a sensible estimate given our own research last calculated that, to recover performance against the waiting list, trusts would need additional investment of £1.8bn to return to a manageable level, with an additional £350m per year after that to meet rising demand.

“Trusts want to minimise the time any of their patients wait for treatment and care. However, they are struggling to balance rising demand for services within a tight financial envelope and amid growing workforce pressures.

“As we seek to implement the NHS long-term plan, we must therefore be realistic about how far the additional funding will stretch across competing priorities.”

Waiting list expert Rob Findlay, who was consulted by NHS Providers when it calculated its assumptions, added: “What the NAO rightly highlights is the need to plan capacity for the whole NHS – elective, diagnostic and non-elective – based on reasonable performance assumptions and not just focus on the areas which are subject to a target.”

An NHS England spokesman said: “The NAO is right to highlight improvements to NHS cancer care, which mean more people are surviving cancer than ever before, and that despite significant increases in demand, more people than [ever] are getting quick tests and hospital treatment.

“As the additional funding to help deliver the NHS long-term plan becomes available from April, local health groups are being allocated the money they need to increase the amount of operations and other care they provide, to cut long waits.”


Waiting list plans could see 250k patients referred to private care