This is a House of Commons Committee report, with recommendations to government. The Government has two months to respond.
This is the full report, read the report summary.
Elective care is typically provided to people who require specialist assessment or treatment by a hospital doctor following a GP referral. Common elective treatments include operations such as hip and knee replacements and cataract surgery. The legal standard for elective care exists to ensure timely treatment and states that 92% of people on the waiting list should be seen within 18 weeks. Before the pandemic only 83% were being seen within 18 weeks and this was 64% in December 2021. Of the 6 million patients waiting for elective care, 311,000 have now been waiting for more than a year. NHSE&I intended to publish an elective recovery plan by the end of November 2021 but only did so in February 2022.
Because of the importance of early diagnosis and treatment, there are more performance standards for cancer and more points in the patient pathway where waiting times are measured. One of the most important relates to the proportion of urgent GP referrals for suspected cancer seen within two weeks: the operational standard is 85% but performance in 2019–20 was 77% and this had dropped to 67% in December 2021.
1. The Department has overseen years of decline in the NHS’s cancer and elective care waiting time performance and, even before the pandemic, did not increase capacity sufficiently to meet growing demand. The NHS has not met the 18-week maximum waiting time standard for elective care since February 2016 nor, in totality, the eight key standards for cancer care since 2014. As demand for services rose faster than supply in the years before the pandemic, performance against waiting times standards declined but the Department neither adjusted these standards to realistic levels nor sought to hold NHSE&I to account adequately. This Committee’s June 2019 report NHS waiting times for elective and cancer treatment concluded that the Department allowed NHS England to be selective about which standards it focused on, reducing accountability.
Recommendation: The Department must strengthen its arrangements for holding NHSE&I to account for its performance against waiting times standards for elective and cancer care. This should include specific expectations for improving waiting time performance in 2022–23. The Department should write to us alongside its Treasury Minute response to set out the specific and measurable performance indicators for elective and cancer care it has put in its 2022–23 mandate to NHSE&I.
2. At our evidence session the Department and NHSE&I appeared unwilling to make measurable commitments about what new funding for elective recovery would achieve in terms of additional NHS capacity and reduced patient waiting times. NHSE&I will receive an additional £8 billion for elective care recovery and £5.9 billion for capital between 2022–23 and 202425. Government expects that this additional funding will enable elective care activity to be 30% higher than pre-pandemic levels. However, the Department and NHSE&I have not set out in meaningful detail what the money will be spent on. NHSE&I is planning for 566 more elective care beds, but this appears to be a small number compared with the scale of the problem.
Recommendation: In implementing its elective recovery plan, NHSE&I should set out clearly:
3. The NHS will be less able to deal with backlogs if it does not address longstanding workforce issues and ensure the existing workforce, including in urgent and emergency care and general practice, is well supported. NHSE&I believes it will be 2 or 3 years before there is a material increase in NHS capacity as a result of the changes it plans to elective care. Large numbers of people waiting for so long presents a huge risk to primary care and emergency services (such as general practice and A&E) because unmet health demand can result in more GP appointments and more medical emergencies. Evidence from the University of Manchester’s Voices of COVID-19 project highlights the concerns of frontline NHS staff regarding the public dissatisfaction they face and the NHS’s lack of capacity to deal with backlogs of care. The Department and NHSE&I need to ensure the NHS workforce is adequately supported and that its service recovery planning is integrated with its planning for staffing and other types of resources.
Recommendation: In implementing its recovery plan NHSE&I’s should publish its assessment of how the size of the NHS workforce (GPs, hospital doctors and nurses) will change over the next three years, so that there is transparency about the human resources that the NHS has available to deal with backlogs.
4. It will be very challenging for the NHS to focus sufficiently on the needs of patients when it comes to dealing with backlogs, both patients already on waiting lists and those who have avoided seeking or been unable to obtain healthcare in the pandemic. NHSE&I is concerned about those people who have avoided or been unable to obtain healthcare during the pandemic. This includes the estimated 240,000 to 740,000 missing urgent cancer referrals since February 2020. There is also the huge challenge of communicating effectively with the 6 million people already waiting for elective care and providing them with support that they may require. NHSE&I expects trusts to focus on treating patients who have been waiting the longest.
Recommendation: The Department and NHSE&I must ensure there is a strong focus on patient needs in all their recovery planning, including:
5. Waiting times for elective and cancer treatment are too dependent on where people live and there is no national plan to address this postcode lottery. In September 2021, patients in the worst-performing geographic areas were more than twice as likely as patients in the best-performing areas to have been waiting over 18 weeks for elective care or more than 62 days for cancer treatment following an urgent referral. The difference between the worst and best areas in the proportion of patients waiting over 52 weeks for elective care was around 12 times. NHSE&I is expecting the same levels of improvement across NHS areas but, if this were the end result, it would mean continuing large disparities between these areas.
Recommendation: NHSE&I should investigate the causes of variations between its 42 geographic areas and provide additional support for recovery in those that face the biggest challenges. NHSE&I should write to us in December 2022 on the actions it has taken to address geographical disparities in waiting times for cancer and elective care and include a summary of any analysis it has done on differences in health outcomes for elective and cancer care in different parts of the country since the start of the pandemic.
6. For the next few years it is likely that waiting time performance for cancer and elective care will remain poor and the waiting list for elective care will continue to grow. The UK has low numbers of healthcare resources per person compared with similar countries and actions taken now to increase its resources will likely take years to be realised. We are concerned that officials are too optimistic about the resilience of NHS services in the short- and medium-term, particularly as NHS staff have been working under continuously high pressure during the pandemic and the system is yet to feel the full effect of missing cancer and elective patients returning for care. The National Audit Office estimates that the elective care waiting list might grow to around 7 million people by March 2025, compared with 6.075 million in December 2021, even if the NHS manages to increase elective activity to its stated aim of 30% above pre-pandemic levels.
Recommendation: The Department and NHSE&I must be realistic and transparent about what the NHS can achieve with the resources it has and the trade-offs that are needed to reduce waiting lists. In implementing its elective recovery plan, NHSE&I should set out clearly what patients can realistically expect in terms of waiting times for elective and cancer treatment. By the time of the next Spending Review at the latest, the Department and NHSE&I should have a fully costed plan to enable legally binding elective and cancer care performance standards to be met once more.
1. On the basis of a report by the Comptroller and Auditor General, we took evidence from the Department of Health and Social Care (the Department) and NHS England and NHS Improvement (NHSE&I) about the backlogs and waiting times for elective and cancer care in the NHS in England. We also received and considered written evidence from 40 organisations.1
2. The NHS provides elective care, typically to people who require specialist assessment and subsequent treatment by a hospital doctor following GP referral. Common elective treatments include operations such as hip and knee replacements and cataract surgery. The legal standard for elective care was introduced in April 2013. It exists to ensure timely treatment and states that 92% of the waiting list should be seen within 18 weeks. Before the pandemic only 83% of the elective waiting list were being seen within 18 weeks and this had declined to 64% in December 2021. Of the 6 million people waiting for elective care, 311,000 have been waiting for more than a year.2
3. The NHS also provides cancer services to assess people with suspected cancer symptoms and to diagnose and treat those with cancers. Because of the importance of early diagnosis and treatment, there are more performance standards for cancer and more points in the patient pathway where waiting times are measured than for elective care. One of the most important cancer standards relates to the proportion of urgent GP referrals for suspected cancer treated within 62 days. This standard exists to ensure that people who present to their GP with urgent symptoms start the necessary treatment quickly. The operational standard is 85% but performance in 2019–20 was 77% and this had dropped to 67% in December 2021.3
4. At the time of publication of the C&AG’s Report, statistics on NHS performance on elective and cancer waiting times were available up to September 2021. They have subsequently been published up to December 2021. The latest statistics (Figure 1) show that there has been no improvement in the headline percentage waiting time indicators.
Figure 1
Changes in headline waiting time performance (September – December 2021)
|
Waiting time indicator |
September 2021 (from C&AG’s Report) |
December 2021 (published on 10 February 2022) |
|
Percentage of people on the elective care waiting list for less than 18 weeks |
66% (3.88 million out of 5.83 million) |
64% (3.87 million out of 6.00 million) |
|
Percentage of people on the elective care waiting list for more than 12 months |
5% (301,000 out of 5.83 million) |
5% (311,000 out of 6.07 million) |
|
National percentage of cancer treatments within 62 days of urgent referral, where the minimum should be 85% |
68% (10,109 out of 14,866) |
67% (9,462 out of 14,132) |
Source: C&AG’s Report, page 4 and NHS England’s published waiting times statistics
5. NHS waiting time performance had declined steadily in the years before the COVID-19 pandemic. The statutory 92% elective care waiting time standard was last met in February 2016. The eight operational performance standards for cancer care were last met in totality in 2014.4 Five Royal Colleges submitted evidence to us. On the situation before the pandemic, the Royal College of Emergency Medicine told us that elective surgery was compromised every winter due to increased emergency demand and a lack of hospital capacity. It added that many emergency departments experienced crowding and corridor care all year round.5 The Royal College of Radiologists told us that cancer and imaging services were already overstretched before the COVID-19 pandemic.6 The Royal College of Surgeons and the Royal College of Pathologists told us of workforce shortages before COVID-19.7
6. We asked the Department about the financial constraints the NHS had been operating under in the years when performance was declining. The Department told us that the basic cause of decline in waiting time performance was that the supply of NHS services had not risen as fast as demand for those services.8 NHSE&I explained that before the pandemic the NHS was in a position where lots of issues needed attention and improvement; it said this was what the NHS Long-Term Plan had been meant to address.9 Further to this, the Department explained that, just before the pandemic, it had been discussing with the NHS a five-year plan to make best use of additional investment in the hope of recovering or partially recovering the waiting list position. Clearly both the Long-Term Plan and the five-year plan have been thrown off course by COVID-19.10
7. But plans are only one part of the explanation for deteriorating performance. This Committee’s June 2019 report NHS waiting times for elective and cancer treatment concluded that the Department had allowed NHS England to be selective about which standards it focused on, reducing accountability. We recommended that the Department and NHSE&I clarify to the Committee how NHSE should be held accountable, a recommendation with which the government agreed.11 We heard from the Department that it did not formally change the waiting times standards when waiting times performance declined before the pandemic but it had accepted that given the pressure in the system clinicians would focus on the clinical priorities of individual patients instead.12 We asked the Department about how it planned to hold the NHS to account for the additional funding that it is now set to receive for elective recovery. An elective recovery plan had been scheduled for publication in November 2021 but had been delayed.13 The Department told us it had so far been interrupted from focussing on elective care recovery by the Omicron wave of COVID-19 but that it accepted the need for detailed plans encompassing the necessary elements of funding, capacity, workforce, organisation and clinical decision-making.14 (The recovery plan was subsequently published in February 2022).15 The Department also explained that it would continue to set the top-level measures for the NHS through the NHS mandate, and it asserted that waiting time performance standards remained meaningful.16 Clarity about what and how the Department is measuring NHS performance is vital because it relates directly to how patients experience the NHS.
8. The C&AG’s Report included two plausible scenarios under which the waiting list will be even longer in 2025 than it was in 2021. One of these scenarios assumed that the NHS would achieve the 30% increase in activity that is now the government’s stated aim. We asked why more could not be done with the additional £8 billion of funding for elective recovery from 2022–23 to 2024–25.17 NHSE&I said there was significant uncertainty about the exact size of the future waiting list due to uncertainty over the rate at which missing referrals returned to seek care and the ongoing impact of COVID-19.18 However, it told us that in its judgement it would be very hard to reduce the size of the overall waiting list by 2025. It explained that it was more confident about reducing the number of very long waiters.19
9. We sought reassurance that all additional funding would be well spent and asked for examples of the measurable improvements that we could reasonably expect to see. We heard generally from the Department that with the additional £8 billion recovery funding it wanted to restore activity to the highest level possible and that the £5.9 billion of capital funding would enable a total of 9 million additional health checks, scans and procedures by 2024. More specifically, NHSE&I stated that in the second half of 2021–22 it would spend £700 million to create additional theatres, surgical hubs and diagnostic facilities and to start the separation of urgent and elective care so that urgent care is less able to disrupt elective care.20 It said these actions together would increase the number of beds available for elective care by 566 by March 2022.21 This is welcome but very small in scale: for comparison, the number of general and acute beds available daily between November 2020 and September 2021 was on average around 86,000 beds.22
10. Between 2010 and 2019 the NHS saw an average annual growth in emergency admissions of more than 3% and in urgent cancer referrals from GPs of more than 10%. Although there was relatively strong growth in the number of consultants (over 3% per year) during that period, there was almost no change in nurse numbers and a reduction of 1.1% per year in the number of general and acute beds available for overnight use.23 We examined the additional capacity the NHS would require to deliver reductions in waiting lists. NHSE&I told us that additional health workers were needed across the NHS and in multiple roles. It explained that a medium-term approach was needed as time was required to recruit and train people and to get them paired with up-to-date diagnostic and other infrastructure, and that it would be two to three years before there was any material increase in NHS capacity. This increase of capacity is a prerequisite for reducing waiting lists.24
11. The very large numbers of people who have not presented for healthcare, or were not able to obtain it, during the pandemic, as well as those who have already been on waiting lists for long periods of time present a huge risk to primary and emergency care services. This is because unmet health demand can result in more GP appointments and more medical emergencies as people try to manage or suffer the consequences of their conditions. In a survey by NHS Providers, almost all NHS trust leaders responding reported that the complexity and acuity of new patients had increased since the pandemic.25 In written evidence, the British Medical Association told us that people who were waiting might seek support from “already overstretched” GPs and that this would have a knock-on effect on the number of GP appointments available to patients seeking an initial consultation, perhaps further increasing the number of missing patients.26 NHSE&I acknowledged that it was asking GPs to do a lot at the moment.27
12. The University of Manchester’s Voices of COVID-19 project has interviewed over 2,000 NHS staff to provide a national collection of testimonies in partnership with the British Library. This evidence highlights the concerns of frontline NHS staff regarding the public dissatisfaction they face and the NHS’s lack of capacity to deal with backlogs of care. The submission stated that since summer 2021 interviewees had described less tolerance from patients for delays in treatment and appointments, and patients becoming less understanding about the continued impact of COVID-19 on the NHS’s ability to provide healthcare.28 Sadly, there had also been increasing evidence of some patients complaining to and verbally abusing NHS staff. We heard from NHSE&I that it was concerned about how exhausted many NHS staff were and that it was seeking to support staff wellbeing.29 Specifically for GPs, the Department told us that it was making investments so that GPs could more quickly access specialist advice to help them support their patients.30
13. This Committee’s September 2020 report, NHS nursing workforce, concluded that there was a risk that the NHS was focusing on short-term pressures at the expense of the necessary long-term strategy when it came to staffing.31 Similar risks exist in the current situation. In written evidence, the King’s Fund told us that any plan to reduce waiting times needed to build explicitly from an analysis of existing staff and the potential for workforce growth alongside a realistic assessment of any scope for productivity improvements.32
14. The Department and NHSE&I are now managing a large, growing and diverse set of challenges to elective and cancer care on top of the ongoing pandemic. We asked how the Department and NHSE&I expected the accelerated and expanded vaccine booster programme, announced on 12 December 2021, to impact on elective and cancer care. NHSE&I told us that GPs would be asked to focus on vaccinations and that people would be asked to forego some routine GP appointments. It stated that there was uncertainty over the size of any COVID-19 wave in January 2022 but that it would only cancel elective care where it had to and that it planned to keep going with high-priority emergency treatments, cancer operations and operations for life-threatening conditions.33
15. The number of missing referrals and the size of the waiting list make for a daunting situation when it comes to the needs of patients. Thinking about the recent changes to GPs’ workload to allow them to focus on booster vaccinations, we asked how members of the public could know in advance whether a GP appointment was routine or urgent, particularly with regard to potential cancer symptoms. NHSE&I told us that it was trying to encourage an increase in cancer referrals across the whole NHS and that it was most worried about the patients it did not know about. It urged anyone with worrying symptoms to come forward.34 We agree with this call but it does not answer our question about how patients can tell in advance of seeing a medical professional whether their problem is urgent or routine. The C&AG’s Report estimated that, as at September 2021, there were 240,000 to 740,000 missing urgent GP referrals for suspected cancer since February 2020.35
16. There are 6 million people on the waiting list for elective care.36 NHSE&I told us it intends to focus on those with the highest clinical need and priority, and especially in the immediate period, those who have waited the longest time. For long-waiters, NHSE&I stated that its plan for this year would target for treatment those who have waited over two years. Over time, it would target 78-week waiters and then the 52-week waiters.37
17. We asked about how patients other than the longest waiters and those with the highest clinical priority would be supported while they waited. NHSE&I stated that GPs had a role in managing these patients and that it was also asking secondary care clinicians to ensure patients were clearly informed about their position on waiting lists. NHSE&I explained that it has been trying to get NHS commissioners and providers to review regularly whether patients’ clinical priority had changed and to have conversations with patients. NHSE&I accepted that these approaches had not been working as well as they should in all parts of the system; it said it wanted to build the capacity for more reviews in future.38 In evidence submitted to us, the British Heart Foundation stated that services should be appropriately resourced to support patients to self-manage and improve their wellbeing while they waited for treatment; this could not just be about patients being left to fend for themselves but meant regular contact, including timely updates on delays, and signposting to relevant services.39
18. In September 2021, patients in the worst-performing of NHSE&I’s 42 geographic areas of England were more than twice as likely as patients in the best-performing areas to have been waiting over 18 weeks for elective care. Patients were also more than twice as likely to have waited more than 62 days for cancer treatment following an urgent referral in the worst-performing area compared with the best-performing. The difference between the worst and best areas in the proportion of patients waiting over 52 weeks for elective care was around 12 times.40
19. We asked NHSE&I to explain these disparities. It told us that the COVID-19 pandemic had had a differential effect across the country and that the differences reflected where the NHS had most diagnostic capacity and skilled workforce compared with where these resources were more stretched. It also said that the large disparities reflected different levels of demand for healthcare across the country.41 The Health Foundation, in written evidence, stated that, on average, the most socio-economically deprived areas of England faced the biggest backlogs and patients in those areas consequently faced longer delays.42
20. We asked about very long-waiters in different areas and what action NHSE&I was taking to reduce them. It told us that all areas had had the same expectation placed upon them, to attempt to reduce the number of patients who had been waiting for more than two years by the end of 2021–22. It accepted that some areas of the country would struggle more than others to do this and said that it was working on mechanisms to build additional capacity, modify and change health systems and how areas could help each other across the country – including, for instance, by moving clinical teams or patients between regions.43 We also heard from NHSE&I that its elective recovery plan would consider how it could help the whole country to recover at a similar pace, even though areas are starting from different positions.44 The Department considered that transparency of performance data would be a crucial tool in reducing disparities.45
21. Among comparable OECD countries the UK has relatively low numbers of hospital beds, nurses and doctors per 1,000 population and also carries out relatively low numbers of advanced diagnostic examinations.46 NHSE&I told us that it would take two to three years before there was a material increase in NHS capacity. It said that the NHS needed to be training more staff and that it was considering how training capacity could be expanded.47
22. We considered whether officials were planning on the basis of realistic assessments of future demand for healthcare or whether they were being too optimistic. NHSE&I told us that there was lots of risk and uncertainty in the NHS at present because of missing patients and the rate at which they might return but it agreed to do all it could to plan realistically.48 But it also focused mostly on optimistic scenarios for the future. It told us that if demand was “at the better end of the spectrum” and it “did not have disruptions like those we are going to potentially have in the next few weeks” then the NHS would have “a really good run” at reducing waiting lists.49 We asked whether enough long-term resilience was being put in place to deal with known and unexpected risks. NHSE&I told us that one of the biggest known risks was annual winter disruption to elective care and that it was working to address this in the current planning process. Longer-term resilience would be underpinned by a workforce of the right size, the right estate and capital support, and digital transformation, as well as necessary reforms to social care.50
23. NHSE&I emphasised the flexibility of the NHS workforce, as evidenced throughout the pandemic. It said that this workforce flexibility now needed to continue as part of transforming the NHS for the future and recovering elective and cancer care.51 In written evidence, the Health Foundation told us that serious staff shortages were compounded by the fact that staff were exhausted by their experience of the past 18 months, with the NHS Staff Survey for 2020 showing that 44% of staff reported feeling unwell as a result of work-related stress, the highest result over the past five years.52 This is the situation before the health system begins to feel the full effects of missing cancer and elective patients returning for care. Under a plausible scenario of 50% of missing patients returning and the NHS achieving a 30% increase in activity by 2024–25 compared with pre-pandemic levels, the National Audit Office estimates that the waiting list will be 7 million in March 2025, around one million higher than it was in December 2021.53 As noted by The King’s Fund, national leaders will need to decide which areas to prioritise and be honest with the public about the knock-on effects of the care they can expect to receive.54
Members present:
Dame Meg Hillier, in the Chair
Shaun Bailey
Dan Carden
Sir Geoffrey Clifton-Brown
Mr Mark Francois
Peter Grant
Kate Green
Craig Mackinlay
Sarah Olney
Nick Smith
Draft Report (NHS backlogs and waiting times in England), proposed by the Chair, brought up and read.
Ordered, That the draft Report be read a second time, paragraph by paragraph.
Paragraphs 1 to 23 read and agreed to.
Summary agreed to.
Introduction agreed to.
Conclusions and recommendations agreed to.
Resolved, That the Report be the Forty-fourth of the Committee to the House.
Ordered, That the Chair make the Report to the House.
Ordered, That embargoed copies of the Report be made available, in accordance with the provisions of Standing Order No. 134.
Adjourned till Wednesday 9 March at 1.00pm
The following witnesses gave evidence. Transcripts can be viewed on the inquiry publications page of the Committee’s website.
Sir Chris Wormald, Permanent Secretary, Department of Health and Social Care; Matthew Style, Director General NHS Policy and Performance Group, Department of Health and Social Care; Amanda Pritchard, Chief Executive, NHS England; Professor Stephen Powis, National Medical Director, NHS England; Sir James Mackey, National Director of Elective Recovery, NHS EnglandQ1–118
The following written evidence was received and can be viewed on the inquiry publications page of the Committee’s website.
NHS numbers are generated by the evidence processing system and so may not be complete.
1 Alzheimer’s Research UK (NHS0026)
2 Alzheimer’s Society (NHS0019)
3 Antoniou, Mr Christopher (NHS0001)
4 Association of British HealthTech Industries (NHS0006)
5 Association of Medical Research Charities (NHS0028)
6 Bowel Cancer UK (NHS0045)
7 British Dental Association (NHS0032)
8 British Heart Foundation (NHS0031)
9 British Medical Association (NHS0022)
10 British Psychological Society (NHS0030)
11 Cancer Research UK (NHS0002)
12 Crohn’s & Colitis UK (NHS0038)
13 Diabetes UK (NHS0025)
14 Eli Lilly and Company (NHS0011)
15 Heart Valve Voice (NHS0017)
16 Independent Age (NHS0012)
17 Independent Healthcare Providers Network (IHPN) (NHS0021)
18 JDRF (NHS0008)
19 Lambert, Dr Michael (NHS0042)
20 Macmillan Cancer Support (NHS0024)
21 Medical Technology Group (NHS0015)
22 Menstrual Health Coalition (NHS0013)
23 NHS Confederation (NHS0039)
24 NHS Property Services (NHS0027)
25 NHS Providers (NHS0043)
26 NHS Voices of Covid-19 at the University of Manchester (NHS0010)
27 Nuffield Trust (NHS0037)
28 POhWER (NHS0029)
29 Parkinson’s UK (NHS0014)
30 Policy Exchange (NHS0041)
31 Royal College of Emergency Medicine (NHS0040)
32 Royal College of Obstetricians and Gynaecologists (NHS0033)
33 Royal College of Pathologists (NHS0004)
34 Royal College of Radiologists (NHS0003)
35 Royal College of Surgeons of England (NHS0020)
36 Spire Healthcare (NHS0016)
37 Staffordshire University (NHS0005)
38 The Health Foundation (NHS0044)
39 The King’s Fund (NHS0007)
40 The Urology Trade Association (NHS0009)
All publications from the Committee are available on the publications page of the Committee’s website.
|
Number |
Title |
Reference |
|
1st |
Low emission cars |
HC 186 |
|
2nd |
BBC strategic financial management |
HC 187 |
|
3rd |
COVID-19: Support for children’s education |
HC 240 |
|
4th |
COVID-19: Local government finance |
HC 239 |
|
5th |
COVID-19: Government Support for Charities |
HC 250 |
|
6th |
Public Sector Pensions |
HC 289 |
|
7th |
Adult Social Care Markets |
HC 252 |
|
8th |
COVID 19: Culture Recovery Fund |
HC 340 |
|
9th |
Fraud and Error |
HC 253 |
|
10th |
Overview of the English rail system |
HC 170 |
|
11th |
Local auditor reporting on local government in England |
HC 171 |
|
12th |
COVID 19: Cost Tracker Update |
HC 173 |
|
13th |
Initial lessons from the government’s response to the COVID-19 pandemic |
HC 175 |
|
14th |
Windrush Compensation Scheme |
HC 174 |
|
15th |
DWP Employment support |
HC 177 |
|
16th |
Principles of effective regulation |
HC 176 |
|
17th |
High Speed 2: Progress at Summer 2021 |
HC 329 |
|
18th |
Government’s delivery through arm’s-length bodies |
HC 181 |
|
19th |
Protecting consumers from unsafe products |
HC 180 |
|
20th |
Optimising the defence estate |
HC 179 |
|
21st |
School Funding |
HC 183 |
|
22nd |
Improving the performance of major defence equipment contracts |
HC 185 |
|
23rd |
Test and Trace update |
HC 182 |
|
24th |
Crossrail: A progress update |
HC 184 |
|
25th |
The Department for Work and Pensions’ Accounts 2020–21 – Fraud and error in the benefits system |
HC 633 |
|
26th |
Lessons from Greensill Capital: accreditation to business support schemes |
HC 169 |
|
27th |
Green Homes Grant Voucher Scheme |
HC 635 |
|
28th |
Efficiency in government |
HC 636 |
|
29th |
The National Law Enforcement Data Programme |
HC 638 |
|
30th |
Challenges in implementing digital change |
HC 637 |
|
31st |
Environmental Land Management Scheme |
HC 639 |
|
32nd |
Delivering gigabitcapable broadband |
HC 743 |
|
33rd |
Underpayments of the State Pension |
HC 654 |
|
34th |
Local Government Finance System: Overview and Challenges |
HC 646 |
|
35th |
The pharmacy early payment and salary advance schemes in the NHS |
HC 745 |
|
36th |
EU Exit: UK Border post transition |
HC 746 |
|
37th |
HMRC Performance in 2020–21 |
HC 641 |
|
38th |
COVID-19 cost tracker update |
HC 640 |
|
39th |
DWP Employment Support: Kickstart Scheme |
HC 655 |
|
40th |
Excess votes 2020–21: Serious Fraud Office |
HC 1099 |
|
41st |
Achieving Net Zero: Follow up |
HC 642 |
|
42nd |
Financial sustainability of schools in England |
HC 650 |
|
43rd |
Reducing the backlog in criminal courts |
HC 643 |
|
1st Special Report |
Fifth Annual Report of the Chair of the Committee of Public Accounts |
HC 222 |
|
Number |
Title |
Reference |
|
1st |
Support for children with special educational needs and disabilities |
HC 85 |
|
2nd |
Defence Nuclear Infrastructure |
HC 86 |
|
3rd |
High Speed 2: Spring 2020 Update |
HC 84 |
|
4th |
EU Exit: Get ready for Brexit Campaign |
HC 131 |
|
5th |
University technical colleges |
HC 87 |
|
6th |
Excess votes 2018–19 |
HC 243 |
|
7th |
Gambling regulation: problem gambling and protecting vulnerable people |
HC 134 |
|
8th |
NHS capital expenditure and financial management |
HC 344 |
|
9th |
Water supply and demand management |
HC 378 |
|
10th |
Defence capability and the Equipment Plan |
HC 247 |
|
11th |
Local authority investment in commercial property |
HC 312 |
|
12th |
Management of tax reliefs |
HC 379 |
|
13th |
Whole of Government Response to COVID-19 |
HC 404 |
|
14th |
Readying the NHS and social care for the COVID-19 peak |
HC 405 |
|
15th |
Improving the prison estate |
HC 244 |
|
16th |
Progress in remediating dangerous cladding |
HC 406 |
|
17th |
Immigration enforcement |
HC 407 |
|
18th |
NHS nursing workforce |
HC 408 |
|
19th |
Restoration and renewal of the Palace of Westminster |
HC 549 |
|
20th |
Tackling the tax gap |
HC 650 |
|
21st |
Government support for UK exporters |
HC 679 |
|
22nd |
Digital transformation in the NHS |
HC 680 |
|
23rd |
Delivering carrier strike |
HC 684 |
|
24th |
Selecting towns for the Towns Fund |
HC 651 |
|
25th |
Asylum accommodation and support transformation programme |
HC 683 |
|
26th |
Department of Work and Pensions Accounts 2019–20 |
HC 681 |
|
27th |
Covid-19: Supply of ventilators |
HC 685 |
|
28th |
The Nuclear Decommissioning Authority’s management of the Magnox contract |
HC 653 |
|
29th |
Whitehall preparations for EU Exit |
HC 682 |
|
30th |
The production and distribution of cash |
HC 654 |
|
31st |
Starter Homes |
HC 88 |
|
32nd |
Specialist Skills in the civil service |
HC 686 |
|
33rd |
Covid-19: Bounce Back Loan Scheme |
HC 687 |
|
34th |
Covid-19: Support for jobs |
HC 920 |
|
35th |
Improving Broadband |
HC 688 |
|
36th |
HMRC performance 2019–20 |
HC 690 |
|
37th |
Whole of Government Accounts 2018–19 |
HC 655 |
|
38th |
Managing colleges’ financial sustainability |
HC 692 |
|
39th |
Lessons from major projects and programmes |
HC 694 |
|
40th |
Achieving government’s long-term environmental goals |
HC 927 |
|
41st |
COVID 19: the free school meals voucher scheme |
HC 689 |
|
42nd |
COVID-19: Government procurement and supply of Personal Protective Equipment |
HC 928 |
|
43rd |
COVID-19: Planning for a vaccine Part 1 |
HC 930 |
|
44th |
Excess Votes 2019–20 |
HC 1205 |
|
45th |
Managing flood risk |
HC 931 |
|
46th |
Achieving Net Zero |
HC 935 |
|
47th |
COVID-19: Test, track and trace (part 1) |
HC 932 |
|
48th |
Digital Services at the Border |
HC 936 |
|
49th |
COVID-19: housing people sleeping rough |
HC 934 |
|
50th |
Defence Equipment Plan 2020–2030 |
HC 693 |
|
51st |
Managing the expiry of PFI contracts |
HC 1114 |
|
52nd |
Key challenges facing the Ministry of Justice |
HC 1190 |
|
53rd |
Covid 19: supporting the vulnerable during lockdown |
HC 938 |
|
54th |
Improving single living accommodation for service personnel |
HC 940 |
|
55th |
Environmental tax measures |
HC 937 |
|
56th |
Industrial Strategy Challenge Fund |
HC 941 |
1 C&AG’s Report, NHS backlogs and waiting times in England, Session 2021–22, HC 859, 1 December 2021
2 C&AG’s Report, pages 4 and 17; NHS England’s published waiting times statistics for November 2021
3 C&AG’s Report, pages 27 and 28; NHS England’s published waiting time statistics for November 2021
4 C&AG’s Report, pages 20, 27
5 NHS0040 Royal College of Emergency Medicine submission para 2
6 NHS0003 Royal College of Radiologists submission para 3
7 NHS0004 Royal College of Pathologists submission para 2; NHS 0020 Royal College of Surgeons submission para 10
8 Q24
9 Q27
10 Q26
11 Committee of Public Accounts, NHS waiting times for elective and cancer treatment, 100th report of session 2017–19, HC 1750, para 2; HM Treasury, Treasury Minutes Progress Report, CP313, November 2020, para 2.1, page 159
12 Q28
13 Health and Social Care Committee, Clearing the backlog caused by the pandemic, ninth report of session 2021–22, HC 599, para 5
14 Q31
15 NHS England & NHS Improvement, Delivery plan for tackling the COVID-19 backlog of elective care, February 2022
16 Q100
17 C&AG’s Report, pages 36, 40
18 Q40
19 Q44
20 Qq 46, 47
21 Q43
22 C&AG’s Report, page 32
23 C&AG’s Report, page 30
24 Qq 69, 75
25 NHS0043 NHS Providers submission para 3a
26 NHS0022 British Medical Association submission para 3.7
27 Q103
28 NHS0010 University of Manchester submission para 3a
29 Q74
30 Q102
31 Committee of Public Accounts, NHS nursing workforce, 18th Report of Session 2019–21, HC 408, 23 September 2020
32 NHS0007 King’s Fund submission page 4
33 Q32
34 Q76
35 C&AG’s Report, page 4
36 NHS England’s published waiting times statistics for December 2021
37 Q71
38 Q103
39 NHS0031 British Heart Foundation submission 28d
40 C&AG’s Report, pages 24, 29
41 Q90
42 NHS0044 The Health Foundation submission page 3
43 Q93
44 Q92
45 Q94
46 C&AG’s Report, page 31
47 Q69
48 Q106
49 Q107
50 Q111
51 Q72
52 NHS0044 The Health Foundation submission page 6
53 C&AG’s Report, page 36 and published NHS waiting times statistics
54 NHS0007 King’s Fund submission page 5