National Audit Office: NHS England’s 2022 Elective Care transformation programmes did not meet all targets
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NHS England's (NHSE) three elective care transformation programmes
have not fully met their goals to help reduce how long people spend
waiting for elective care. A better understanding is required of
the outcomes for patients and whether NHSE is spending in the right
places to secure value for money, as stated by a new National Audit
Office (NAO) report. In February 2022, NHSE published its elective
care recovery plan to see more patients sooner and prioritise
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NHS England's (NHSE) three elective care transformation programmes have not fully met their goals to help reduce how long people spend waiting for elective care. A better understanding is required of the outcomes for patients and whether NHSE is spending in the right places to secure value for money, as stated by a new National Audit Office (NAO) report. In February 2022, NHSE published its elective care recovery plan to see more patients sooner and prioritise patients waiting the longest. The NHS last met its elective care waiting standard, for patients to begin treatment within 18 weeks from referral, in 2015. So far in 2024-25 the NHS has delivered a 116% increase in activity, compared to 19/20 baseline levels, but fell short of its 129% target. NHSE has broadly achieved its aim of eliminating waits of more than 2 years and more than 18 months but it will not achieve its target to eliminate waits of more than a year by March 2025. NHSE told the NAO that there were several factors that weren't included in their planning assumptions that reduced its ability to deliver the targets, including industrial action, lower than expected productivity, and higher than expected levels of COVID-19 infection, demand for urgent care and inflation during 2023 and 2024. The independent public spending watchdog's latest report takes a closer look at NHSE's management of the three transformation programmes - diagnostic, surgical and outpatient:
NHSE's management and oversight of the programmes could be improved. Governance arrangements for the programmes have not been effective, with gaps in data reported, inconsistent reporting of key indicators and a lack of reporting of progress against milestones. NHSE's oversight board for elective recovery does not assess whether NHSE has the right balance of investment across the programmes to reduce waiting lists and NHSE was slow to make significant changes to the outpatients' programme when it was not delivering.
NHSE's new 2025 elective care reform plan has taken on board lessons learned to date from the transformation programmes, although there is still scope for further improvement. The NAO report recommends:
Gareth Davies, head of the NAO, said: “To achieve its aims on elective reform NHSE will need to make sure all its transformation programmes are delivering quicker access to treatment for patients as planned. This has not consistently been the case so far.” “With its reset of how it manages its programmes NHSE has an opportunity to ensure that it learns from its experience in the first phase of the programmes – particularly where it has failed to meet its targets – and there is some evidence that it has started to apply these lessons.”
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