Scope of the inquiry
The Department of Health and Social Care (the Department) has a number of waiting times performance standards, which describe the percentage of patients that NHS bodies must treat within maximum waiting times:
- For elective treatment (the treatment of non-urgent conditions, covering general medicine, neurosurgery and orthopaedics), the aim is for 92% of patients to be seen by a consultant within 18 weeks after referral;
- For cancer assessment, the aim is for 93% of patients to be seen by a cancer specialist within 2 weeks of an urgent GP referral where cancer is suspected; and
- For cancer treatment, the aim is for 85% of patients to wait no longer than 62 days from urgent GP referral to first treatment.
However, a recent National Audit Office (NAO) report has found that while the NHS has increased the number of people it treats each year, the percentage of patients treated within waiting time standards continues to decline for both elective and cancer treatment. The 92% target for elective care was last met nationally in February 2016 and the 85% target for cancer treatment has not been met since the end of 2013.
The report identified that there is significant variation across England in terms of waiting times. In 2017-18, the number of patients waiting less than 18 weeks for their elective care varied between 75% and 96% across clinical commissioning groups (CCGs). For cancer treatment, the percentage of patients treated within 62 days ranged from 59% to 93%. There is also variation across specialities: performance for lung, lower gastrointestinal and urological cancers was significantly lower than other cancers.
The number of referrals has increased, which has had a knock-on effect on waiting times. For instance, between 2010-11 and 2017-18, the number of patients referred urgently for suspected cancer increased by 94%. The NAO report found that, for cancer, this is due to NHS England’s policy of encouraging more urgent referrals to improve early cancer diagnosis; this has improved early diagnosis of cancer and improved survival rates. However, it also found that NHS England’s understanding of the increase in elective care referrals is limited. Nevertheless, the report found that constraints on capacity, including a lack of finance, staff and beds is linked with the decline in waiting time performance.
On 24 April, the Public Accounts Committee will question the heads of the Department of Health and Social Care and NHS England on the action they are taking to address declining waiting time performance. In the context of rising demand and increasing constraints on capacity, the Committee will explore variation between different areas of the country, the impact of delays on patients and factors such as staff shortages and bed capacity.