NHS misses targets and still pockets £1.4 billion

The Department of Health said higher-than-expected levels of Covid and doctors strikes had hampered attempts to cut record NHS waiting lists
The Department of Health said higher-than-expected levels of Covid and doctors strikes had hampered attempts to cut record NHS waiting lists - sturti/iStockphoto

The NHS failed to meet targets linked to £1 billion of taxpayer funding but was allowed to keep the money anyway, The Telegraph can disclose.

Ministers let the health service keep the entire £1.4 billion funding pot that was conditional on hospitals meeting targets to reduce the Covid backlog last year, despite the NHS failing to meet the targets associated with the majority of that money.

Gareth Davies, the head of the National Audit Office (NAO), which oversees public spending, refused to sign off the Department of Health’s annual accounts for 2022-23 in their entirety, instead giving only giving his “qualified” approval.

Labour said the disclosure demonstrated the Conservatives’ “mismanagement” of the health service, saying that patients and taxpayers would be “perplexed” that the money had not led to the additional operations it was intended to fund.

It is likely to fuel concerns among Tory MPs about the potential for a public backlash at the next election on the party’s handling of the NHS.

With overall NHS waiting lists at a record high of 7.6 million people in November 2023, only 11 per cent of the public now believe that the Conservatives would be the best party to handle the health service – down from 26 per cent in 2019, according to a YouGov poll carried out last month.

‘Unachievable target’

The Department of Health said the target, which required hospitals to exceed their pre-Covid volume of elective activity such as scans and procedures, by 4 per cent, “was unachievable within available funding” because of factors such as higher-than-expected levels of Covid, and doctors strikes between December and March.

It therefore opted “not to implement clawback” – the procedure by which departments can claim back money to which public bodies are not entitled. “This allowed the NHS to maximise elective activity in the given conditions,” the department said.

The funding is from the Elective Recovery Fund, through which ministers are channelling billions of pounds to pay for checks, scans and procedures for patients stuck on waiting lists that ballooned during the pandemic.

It was split between the NHS’s integrated care systems (ICS) that are responsible for hospitals and GP surgeries in each area.

In November, an NAO report warned that 26 out of the 42 ICSs were on course to miss the target of providing 104 per cent of their pre-pandemic elective care in 2022-23.

Ambulances queue at the Royal London Hospital
The NHS has struggled to reduce waiting lists in the wake of the pandemic - VV Shots/iStock

In a note in the Department of Health’s accounts for the period, Mr Davies said: “I received notification from the Department in March 2023 that elective recovery targets had not been met across a number of ICSs, but the associated funding had not been returned to the Consolidated Fund.”

The health department asked the Treasury for a “relaxation” of the rules stipulating that the £1.4 billion was conditional on targets being met by the individual ICSs. At this point, targets associated with £1 billion of the pot had already been missed.

The Treasury agreed to relax the rules for the remaining £400 million but “did not approve a retrospective relaxation of the ringfence for the circa £1.0 billion of funding to ICSs up to that point”, according to Mr Davies’ note.

He added: “The expenditure was not spent in accordance with the framework of authorities because a condition of the funding, meeting elective recovery targets, was not met.”

‘Paying more but getting less’

Wes Streeting, the shadow health secretary, said: “Patients and taxpayers alike will be perplexed and appalled that extra funding for the NHS has not led to more operations. The Conservatives’ mismanagement of the health service over 14 years has left taxpayers paying more but getting less. They have no plan to cut waiting lists or put the NHS on a sustainable footing.

“Only Labour can reform the NHS and make it fit for the future. By paying staff extra to work evenings and weekends, funded by abolishing the non-dom tax status, we will deliver an extra two million operations and appointments a year. Labour’s reform agenda will make sure we get more out of the NHS for what we put in, delivering better value for taxpayers and better care for patients.”

Labour is planning to reintroduce NHS league tables in a move that Mr Streeting has said will put an end to ministers “turning a blind eye to failure”.

A Department of Health spokesman said: “NHS leaders were set ambitious elective care targets in order to bring down the backlog post pandemic, and funding was made available on the condition that targets were met. If not, the funding would need to be returned.

“However, some Integrated Care Systems provided lower levels of elective activity due to ongoing Covid pressures and longer lengths of stay – factors for which no additional funding had been provided. Therefore, providers were able to retain the elective funding to cover these costs.

“The department has put in place additional measures to monitor Elective Recovery Funding and related spending.”

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