NHS England criticised for insufficient tracking of costs and benefits of A&G

NHS England must urgently track the costs and benefits of the expanding advice and guidance (A&G) scheme, MPs have said, warning that the lack of monitoring is part of a pattern of ‘deeply flawed’ reforms risking repetition of major Government failures.

In wider recommendations, MPs on the House of Commons public accounts committee (PAC) raised concerns that NHS 10-year health plan reforms are ‘replicating poor practices seen on the HS2 and New Hospital Programmes’ – with announcements made before delivery plans and funding were secured.

MPs also said they are ‘not confident’ that DHSC is being ‘realistic’ about the effort needed to bring down NHS waiting times, with digital solutions being treated as a ‘cure-all’.

In a report published today, the PAC found that NHSE has failed by ‘significant margins’ to meet its post-Covid recovery goals to shorten patient waiting lists, despite spending £3.24bn on transforming services.

It said that NHS England’s approach to reform is ‘deeply flawed in both monitoring of progress and the delivery of intended outcomes’, citing the expansion of A&G as one of the areas that should be monitored.

The 2025/26 GP contract offered practices access to an £80m A&G funding pot, which enables access to a £20 Item of Service (IoS) fee for ‘pre-referral requests’ as part of a new enhanced service specification. NHS England said it would ‘incentivise even closer working between general practice and secondary care’.

But the PAC said that ultimately DHSC has approved billions of pounds of spending ‘without sufficient focus on what exactly’ expansions of programmes like A&G will deliver.

It said: ‘DHSC and NHSE should set up data collections or processes for tracking costs and benefits as early as possible when setting up new services or transforming existing services including the recent extension of specialist telephone advice to GPs.’

The report also warned that structural changes, including the abolition of NHSE and cuts to ICBs, are being made ‘without secured funding in place’ to pay for the changes or impact assessments.

It said that these changes, ‘especially the planned cuts to local health boards’, could have a ‘significant negative impact on patients and on the workforce’ through the level of ‘uncertainty’ they create.

Earlier this year the PAC had already criticised the Government’s lack of a clear plan for NHS England’s abolition.

The report sought confirmation from DHSC that it will not announce ‘unfunded commitments’, and set out the likely costs of planned redundancies and the absorption of NHSE into DHSC.

It also criticised the 10-year plan’s focus on technology, saying that there is ‘a significant risk’ that digital solutions are being treated as a ‘cure-all’.

It said: ‘The integration and sharing of digital records across the NHS is a key weakness and the NHS lacks some of the basics in IT connectivity, with general practitioners, hospital trusts and consultants still working on different systems. With technology moving quickly, the timing and funding of digital change remains uncertain.’

The committee’s deputy chair Clive Betts said: ‘Alarmingly, in the Government’s approach to the absorption of NHSE and 50% cuts to local health boards, we are now seeing chilling echoes of past failures on HS2 and the New Hospital Programme.

‘Our committee has long established that large unfunded commitments, without plans for delivery, while good at generating headlines, can only end one way.

‘We hope the Government can provide reassurance as part of this inquiry that it can come forward with the underpinning detail that can marry its ambitions to reality.’

Clinical vice president of the Royal College of Physicians Dr Hilary Williams said: ‘Outpatient transformation will depend on practical, patient focused and trusted approaches designed by those delivering care every day.

‘Government policy must break down silos between hospital, community and primary care, commit to support people with chronic disease to live well and avoid multiple fragmented hospital appointments.’

The King’s Fund director of policy Siva Anandaciva said: ‘The task of both reforming the NHS and getting it back on its feet is hard enough. But these changes will now happen at the same time as a massive reorganisation of the NHS.

‘Today’s report is right to question if this restructure could end up being the HS2 of health care policy and cause more distraction at a time when the NHS could be improving services.’

NHS England recently asked GPs to ‘continue prioritising’ A&G and said all referrals for 10 specialties – decided at local level – should be going through A&G.

An NHS England spokesperson said: ‘The NHS has made significant progress on reducing waiting lists, including the first springtime drop this year for 17 years. While there is more to do, we are seeing patients more quickly and are on track to eliminate the longest waits of over 65 weeks as we transform the way we deliver elective care. This is despite challenges including the significant disruption caused by repeated industrial action.’

A DHSC spokesperson said: ‘This Government inherited a broken NHS, with waiting lists soaring and elective services in dire need of modernisation. This report focuses on the previous government, and we have taken immediate and robust action to tackle waiting lists and modernise elective care.

‘For the first time in 15 years waiting lists are falling. Through record investment and modernisation, we’ve cut backlogs by more than 230,000 and smashed our target for additional appointments, delivering more than 5 million extra.

‘Health service productivity is up 2.7% on last year – and just last week, we pressed ahead with halving the headcount of NHSE and DHSC, saving billions to reinvest into the frontline and patient care.’