Pent up demand for care risks further inflating NHS backlog New analysis shows number of ‘missing’ patients since start of pandemic now at 7.5m

27 September 2021

Less than a minute to read

New analysis published today by the Health Foundation shows that while the waiting list for hospital care continues to grow, so too does the number of ‘missing' patients who have not yet been added to the list. There were 7.5 million fewer people referred for routine hospital care between January 2020 and July 2021 than would have been expected based on numbers prior to the pandemic. These ‘missing patients’ are in addition to the record 5.6 million people already on the waiting list.  

This lower than expected number of people referred for hospital care, including for routine procedures such as hip or knee surgery, is likely to be due to a number of reasons. Some people may not have sought treatment for health concerns during the pandemic, while others may have seen their GP but not yet been referred due to the pressure on hospital services during the pandemic. In some instances, care may no longer be needed. 

The analysis comes ahead of a BBC Panorama documentary tonight (Monday 27 September) revealing the scale of the elective care backlog and the impact delays are having on people’s lives. 

The Health Foundation analysis, shared with Panorama, also shows that the pandemic had a much worse effect on the hospital care provided in some areas of England than it did in others. The analysis of 42 local integrated care systems (ICSs) shows that the pandemic significantly reduced the level of routine hospital care performed across the country – in the worst affected area routine hospital care dropped by 37% while in the least affected area there was a 13% reduction.  

The report says the most deprived areas experienced the greatest disruption as a result of the pandemic and have also been slower to recover. On average in England, there were 18% fewer routine hospital treatments completed in 2021 compared to 2019, indicating services have not yet recovered to pre-pandemic levels. However, in the most deprived areas, this figure was 19% whereas in the least deprived areas it was 16%. These small but important differences mask wider variation across ICSs as a whole.*

The Health Foundation is calling on the government to ensure money and resources are distributed to the areas where the need is greatest. 

Tim Gardner, senior policy fellow at the Health Foundation, said: 

'While the government has recently set aside a significant amount of money for tackling the NHS backlog, the scale of the challenge and the number of patients who did not come forward for care during the pandemic mean the waiting list is likely to continue to grow significantly over the next few years. 

'We don’t know when or how many of the missing patients will require NHS care in future, nor what treatment they will need when they do. However, efforts to tackle the elective care backlog will only be effective if the NHS is able to target resources and support towards the patients, services and parts of the country that have been worst affected. 

'COVID-19 affected routine hospital services throughout England, but patients living in the most deprived parts of the country experienced more disruption to their diagnosis and treatment than people living elsewhere. As part of its commitment to levelling up, the government needs to ensure people living in deprived areas are not penalised further as part of the NHS recovery.'


*So far during 2021, the areas that have completed the most routine hospital care compared to 2019 were Nottingham and Nottinghamshire (4% more) and Bath and North East Somerset, Swindon and Wiltshire (1% less). The areas struggling the most to return to 2019 levels of care are Birmingham and Solihull (33% less) and East London (28% less), both of which are in the most deprived 20% of areas in England.

Media contact

Creina Lilburne
020 7664 4647 


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