The already huge backlog for NHS care in England will keep growing for years and could hit anywhere between 7 million and 12 million by early 2025, the National Audit Office (NAO) warned today.
The NHS is facing a “daunting” task in operating on all those awaiting surgery and reducing the long waits for care many people are now facing, the NHS Whitehall spending watchdog said.
Hospitals’ efforts to stop the waiting list soaring from its current 5.83 million will be hampered by the NHS having fewer beds, doctors and other staff, the NAO added. That could prevent it from being able to keep up with the growing numbers of people likely to end up on it in future.
The NAO found that even in the best-case scenario the total number of people waiting for a new hip or knee, cataract removal, cancer care or other procedure by the time the next general election is due in December 2024 will still be more than today’s figure, which is the highest on record. “There is a real risk that the waiting list for patients seeking elective care will be longer in 2025 than it is today,” the government auditors said.
“The NAO’s report has delivered a cold dose of reality about the scale of the challenge facing the NHS in the years ahead,” said Ruth Thorlby, the assistant director of policy at the Health Foundation. Renewed cancellations of NHS surgery caused by the new Omicron variant of Covid-19 could lead to the list ballooning even further, she added.
The key to how much progress the NHS can make is how many of the 7.6 million to 9.1 million “missing” patients, who did not seek care during the pandemic until this September, finally do so in the near future. While the report says that number is unknown, “clearly many will”.
“If 50% of ‘missing’ referrals for elective care return to the NHS and its activity grows only in line with pre-pandemic plans, the elective care waiting list will reach 12 million by March 2025.
“If 50% of ‘missing’ referrals return and the NHS can increase activity by 10% more than was planned, the waiting list in March 2025 will still be 7 million”, the NAO said.
The report comes as NHS England and the Department of Health and Social Care finalise an “elective recovery plan”, which will set out in detail how hospitals will tackle the growing number of people who are having to wait for care. It will propose scrapping tens of millions of hospital outpatient follow-up appointments to free up doctors to do more surgery, a greater use of private hospitals to treat NHS patients, and some patients being offered the chance to have their operation outside their home area.
Ministers often portray the backlog as having been caused by Covid disrupting NHS services and making patients reluctant to seek care. But the NAO points out that the waiting list of people who should be treated within 18 weeks already stood at 4.43 million when the pandemic struck in March 2020 and that the target of dealing with 92% of them within that timeframe had been missed since 2016.
However, the number of people forced to wait more than a year for treatment – which previously happened rarely – rocketed from 1,600 in February 2020 to 301,000 in September this year.
The backlog is a “colossal challenge” for an NHS that is already very busy dealing with an unprecedented demand for care, said Matthew Taylor, the chief executive of the NHS Confederation.
“However, the biggest intervention the government can take is to ensure the right numbers and mix of workers are available to deliver this scale of activity long-term. A record number of people are working in the health service currently but there are still simply not enough staff to meet the healthcare needs of the population.”
An NHS England spokesperson said: “Treating more than half a million patients in hospital for Covid, as well as delivering a world-leading vaccination programme, has inevitably had an impact on some routine and non-urgent care. Yet since the pandemic began the NHS has performed millions of elective procedures and over 450,000 people have started treatment for cancer.”