• Shola Adegoroye

How well is the NHS being held to account over declining waiting times?

Well... It was a fascinating experience yesterday, attending the Public Accounts Committee NHS waiting times for elective and cancer care inquiry.

The most senior NHS directors were summoned to be questioned on the action being taken to address declining waiting times performance as outlined in the National Audit Office report on NHS waiting times for elective and cancer treatment.

Called as witnesses to the hot seats:

·       CEO NHS England - Simon Stevens

·       CEO NHS Improvement - Ian Dalton, CBE

·       Permanent Secretary of the Department of Health and Social Care - Sir Chris Wormald

·       National Medical Director of NHS England - Professor Stephen Powis 

The role of the Public Accounts Committee is:

·       to scrutinise the value for money of public spending 

·       to generally hold the government and its civil servants to account for the delivery of public services.

The crux of the problem is, despite the knowledge that shorter waits and earlier diagnosis are largely key to better outcomes for patients, the NHS is doing a poor job of giving the public assurance that they will be guaranteed treatment for cancer or routine elective care within the stipulated target waiting times. 

The witnesses were questioned for nearly two hours and each provided explanations for the non-compliance. In my 20 years of working within and alongside the NHS, I’ve seen far more rigorous interrogation of non-compliance in a weekly cancer PTL meeting with band 6 managers!

The tone was extremely civil. The environment lent itself to polite questioning and the type of seasoned leaders on the receiving end delivered what felt like generic, high level, political responses. In fairness, the Committee got what they asked for.

There was nothing new to see. The obvious reasons for deteriorating performance were given - significant increases in demand, lack of money, constrained capacity, challenges with workforce, etc. etc...

To give context, the 62-day cancer standard has not been met since 2013 and it’s been over three years of non-compliant performance for the RTT standard. Simply shocking.

Sure, the eagerly awaited review of NHS waiting times targets by Sir Mike Richards (former National Cancer Lead) is expected to determine how ‘fit for purpose’ the current targets are - which of them needs to stay, go, or be adapted. However, right now, these are the targets the public expects the NHS to deliver on.

What stood out as most alarming was the absence of 1) a real recovery action plan, and 2) a realistic timeline for turning around the poor, non-compliant performance.

You’d be hard pressed to find any NHS acute trust or CCG that would not demand or be directed to provide these two crucial elements when performance takes such a noticeable downturn and doesn’t seem to be recovering. 

So, the reality we face up to is that a robust plan and recovery timescale simply don’t exist at national level.  

Over the last year, I have especially noticed an increase in the number of cases reported in the press of delayed cancer diagnoses and the negative impacts these have had on patients, their expected survival rates, and quality of life. I’m also hearing from NHS colleagues that formal complaints of this nature have increased too. 

It seems to me that if in the absence of the Public Account Committee being able to robustly hold the NHS properly to account, we'll have to rely on the patients themselves to.

You can watch the recorded session by following the link:

Author: Shola Adegoroye, Founder and Director of Reach Up Consultancy

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