The National Audit Office has warned there is a real risk waiting lists and delays for treatment within the NHS in England will be longer in 2025 than they are today.
It cautioned that if treatment levels only progressed at pre-pandemic levels around 12 million people could be waiting by 2025, but even a 10% treatment uplift would see a seven million backlog.
This is according to analysis in the NAO’s report which lays bare the challenge faced by the NHS as it tackles increased demand created by the pandemic and the hundreds of thousands of “missing” urgent GP referrals for suspected cancer cases.
The Conservative government is providing the NHS in England with an additional £8bn between 2022-23 and 2024-25 with the intention of increasing elective care activity by 2024-25 by 10%.
However, it’s plans have been criticised as ministers continue to avoid making commitments to fill the massive gaps in the NHS workforce.
The NAO emphasised that since the start of the pandemic, the NHS has had to redirect much of its resources to treat Covid patients and to implement infection, prevention and control measures.
The analysis showed that in January 2021 an average of 24,100 general and acute care beds were being used by Covid-19 patients – 31% of all those occupied.
Between January and September 2021, an average of 35% of unoccupied general and acute care beds had to be set aside for Covid-19 patients.
The report noted Covid disruption has inevitably caused a sharp increase in waiting times and backlogs in a healthcare system that had been operating at very close to its maximum capacity.
By September 2021, there were 5.83m patients on the waiting list for elective care, of whom 1.95m patients had been waiting for more than 18 weeks, including 301,000 waiting for more than a year.
Cancer care delays
By June 2021, NHS cancer services activity had recovered to pre-pandemic levels. However, the data showed that since the start of the pandemic up to September 2021, patients with an urgent GP referral for cancer were more likely to be delayed – 26% had to wait more than 62 days for treatment to start.
The NAO also estimated that there were between 240,000 and 740,000 “missing” urgent GP referrals for suspected cancer during the pandemic.
In addition, the NAO estimates that up to September 2021 between 35,000 and 60,000 fewer people started treatment for cancer than would have been expected.
Over the same period of March 2020 to September 2021 the NAO estimated there were between 7.6 million and 9.1 million fewer referrals for elective care. Although the NAO added that it recognised there was inherent uncertainty about these estimates.
Daunting backlog of 12 million
The report also pointed out it was uncertain how many of the “missing” cases will return to the NHS to seek treatment and over what time period and that the NHS will need to increase its activity to meet this surge in demand.
Even if the NHS can adapt, the report warns the scale of the challenge it faces is daunting. 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 12m 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 7m.
Consequently, the report concluded that addressing backlogs and reducing waiting times will be a multi-faceted challenge for the NHS and that while announcements about additional funding in September and October 2021 answer some questions, important uncertainties about the road to recovery remain.
The report added that increasing the numbers of hospital beds, nurses and doctors beyond the levels already planned could take years because of the time required for capital projects and for training.
And the ongoing Covid pandemic could also continue to affect bed and staff availability in unexpected ways and at short notice, it noted.