New analysis by the Health Foundation shows that, if current trends continue, the waiting list for routine hospital treatment (‘elective care’) in England could rise to over 8 million by next summer, regardless of whether NHS industrial action continues.
The analysis models four different future scenarios to look at the prospects for reducing the waiting list by the end of 2024. It shows that, on current trends, the waiting list could peak at 8 million by August 2024 if there is no further strike action, before starting to fall. If strike action were to continue the waiting list could be 180,000 higher.
The analysis finds that industrial action by consultants and junior doctors has so far lengthened the waiting list by around 210,000, just 3% of the overall size of the list, which totalled 7.75 million at the end of August 2023. The analysis also points out that strikes are also likely to have indirect impacts, by squeezing NHS finances and diverting management attention away from productivity improvement.
Tackling the NHS waiting list is a key priority for the government. NHS England’s elective care recovery plan, published in February 2022, included an expectation that it would be falling by March 2024, while in January 2023, the Prime Minister pledged that ‘NHS waiting lists will fall and people will get care more quickly’. At the time the pledge was made, the waiting list stood at 7.2 million.
The analysis, which features an interactive ‘waiting list calculator’, also includes illustrative better and worse case scenarios. Only in the better case scenario, where the number of completed treatments grows by 10.4% a year, a third faster than currently, would the waiting list fall to the same level as when the Prime Minister made his pledge by the end of 2024. The expectation set out in the elective care recovery plan would not be met under any of the scenarios.
The analysis also shows that monthly referrals for treatment are now back to pre-pandemic levels, and growing at a faster rate, which is a positive sign that patients are coming forward having postponed treatment. The NHS has responded well, with monthly treatments growing at a faster rate than pre-pandemic. But the waiting list is still rising as the number of treatments does not yet exceed the number of referrals.
The analysis notes that efforts to reduce the waiting list could also be disrupted by a new wave of Covid or a bad winter flu season, or by cutbacks to hospital care as a result of financial pressures.
Charles Tallack, Director of Data Analytics at the Health Foundation, said: ‘Despite the progress made by the NHS in increasing activity, the waiting list for elective care in England has now reached over 7.7 million, and is likely to continue to grow for several more months. Behind these numbers are people anxious for a diagnosis, patients in avoidable pain and lives put on hold.
‘While industrial action has a range of impacts on NHS organisations, the strikes have only directly resulted in a small increase in the size of the overall waiting list. Ministers have been quick to blame industrial action for the lack of progress in reducing the waiting list but the roots of this crisis lie in a decade of underinvestment in the NHS, a failure to address chronic staff shortages and the longstanding neglect of social care. The pandemic heaped further significant pressure on an already stressed system but waiting lists were already growing long before Covid.
‘Eliminating the backlog for elective care and returning waiting times to 18 weeks is entirely possible - it was done in the early 2000s and it can be done again. However, it will be very challenging and will require sustained focus, policy action and investment.’
Notes to editors
- The NHS consistently met the 18 week standard – that no less than 92% of patients on the list of those referred for elective care should have been waiting 18 weeks or less – from 2008 to 2015. However, it has not been met since February 2016. The current median wait time is 14.5 weeks.
- In February 2014, the waiting list was at 3m and rose to 4.6m just before the COVID-19 pandemic (February 2020). The waiting list then grew to 6.2 million by February 2022. Latest data (August 2023) show the waiting list is at 7.75m.
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