Background to the report

At the start of the COVID-19 pandemic, the NHS in England had not met its elective waiting time performance standard for four years, nor its full set of eight operational standards for cancer services for six years. Due to the pandemic, the number of people receiving elective and cancer care then reduced sharply. Between March 2020 and August 2022, on average there were 8,300 COVID-19 patients in hospital in England at any one time with peaks in this number during waves of infection. Backlogs of patients, both visible on waiting lists and hidden because they had not yet seen a doctor, grew rapidly.

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In February 2022, NHS England (NHSE) published a plan to recover elective and cancer care over the three years up to March 2025. It has received funding for this recovery, which is taking place at a time when the NHS is managing other major pressures, including ongoing effects of the COVID-19 pandemic, access to primary care, the performance of urgent and emergency care, workforce gaps, and problems with the supply of adult social care.

Scope of the report

This is our second report on backlogs for elective and cancer care. The first, NHS backlogs and waiting times in England (December 2021), examined how and why backlogs had increased. This report examines:

  • the design of NHSE’s recovery plan (Part One);
  • how the NHS has been implementing the plan (Part Two); and
  • the early results, and the ongoing risks NHSE has to manage (Part Three).

The report does not examine the roles of primary care or adult social care in supporting the recovery of elective and cancer care.

Report conclusions

The timeliness of NHS elective and cancer care worsened before 2020 and then to a significantly greater extent during the COVID-19 pandemic. NHSE has put in place a recovery plan, with clear objectives. The Department for Health and Social Care (DHSC) allocated additional funding and NHSE is implementing programmes to increase both capacity and the efficient use of resources. Local NHS Integrated Care Systems have a degree of flexibility in how they apply these programmes depending on their circumstances. Officials, clinicians and managers both nationally and locally are committed to improving the service patients experience. Nevertheless, activity so far in 2022 has continued to lag behind the pre-pandemic level and is well below the planned trajectory. To a significant degree, this is due to an operating context that is more difficult than NHSE allowed for in its plans.

The NHS’s funding package is being eroded by inflation, so that its overall funding up to 2024-25 is set to grow more slowly than the long-term average in real terms. Given progress to date, we are concerned that the 129% activity target and the target to eliminate all waits of longer than 52 weeks by 2025 are at serious risk of not being achieved. There are significant threats to the recovery, including the effects of strain on the workforce, uncertainties about whether new initiatives will be able to deliver results as quickly as NHSE needs them to, and the pressures elsewhere in the NHS and adult social care. If the recovery programme is to deliver value for money NHSE will need to manage the programme in line with best practice. It will need to ensure that all component initiatives are well integrated with one another and that it is agile in responding to results and challenges as they emerge, including supporting local systems to make best use of recovery funding. DHSC has an essential part to play too in holding the NHS to account, providing support and challenge as needed.


Publication details

Press release

View press release (17 Nov 2022)

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