NHS must treat 10% more non-urgent cases a month to reduce backlog – study

Figures show NHS falling behind on target to reduce hefty post-pandemic waiting list in England

The NHS must treat at least 10% more non-emergency hospital cases a month if it wants to reduce the hefty backlog caused by the pandemic, according to new analysis.

From February 2020 to October 2022, the waiting list for non-urgent care in England grew by 2.6m cases – a projected 1.8m more than if the pandemic had not hit.

NHS England’s recovery plan aims to increase capacity by 30% by 2025 compared with pre-pandemic levels, but figures published on Thursday showed that the waiting list in England stood at 7.6m, down just 1.3% from the previous month.

Researchers at the Universities of Edinburgh and Strathclyde examined the number of referrals awaiting treatment between January 2012 and October 2022.

They calculated that an estimated 10.2m fewer referrals were made to elective care from the beginning of the pandemic to 31 October 2022. They then modelled how many of these missing patients might return for care to estimate the potential impact on waiting lists.

NHS trusts would have to treat more than 10% to reverse the increasing trend in waiting lists, the authors conclude. “Even if the ambitious target of 30% increase in capacity is achieved during the next three years, several years (beyond the end of 2025) will be needed for the backlog to clear.”

The research comes as NHS England monthly data published on Thursday revealed the health service is going backwards on some key targets.

Despite a small drop, more than 6 million people are waiting for treatment and hundreds of thousands have been waiting for more than one year.

About 6.39 million patients were waiting for 7.61 million treatments, down from 6.44 million patients and 7.71 million treatments at the end of October. It is the second month the waiting list has fallen.

But the number of patients waiting more than 18 months to start routine treatment at the end of November was 11,168, up from 10,506 at the end of October. In all, more than 355,000 patients have been waiting more than a year for hospital treatment.

Patients needing urgent care were also seen less quickly, the data shows. The NHS recovery plan sets a target for 76% of patients attending A&E to be admitted, transferred or discharged within four hours. But 69.4% of patients in England were seen within four hours in A&E in December 2023, down from 69.7% in November. And more than 44,000 patients had to wait more than 12 hours in English A&E departments to be admitted to hospital, up from 42,854 in November.

Ambulance response times also slowed. On average, ambulances took eight minutes and 44 seconds to respond to the most urgent calls from people with life-threatening illnesses or injuries in December, up from eight minutes and 32 seconds in November and significantly longer than the target standard response time of seven minutes.

In January 2023, the prime minister announced a plan to avoid another NHS winter crisis. He pledged to create another 5,000 beds in English hospitals before winter and reduce bed occupancy rates. But the figures show that well into winter, there were only 4,203 extra beds, while bed occupancy rates have increased since Christmas to 93.2%.

NHS leaders conceded progress in some areas was “slipping” and called for more funding.

Sir Julian Hartley, the chief executive at NHS Providers, said: “Although progress on key recovery targets across urgent and emergency care has slipped, NHS leaders still aim to meet these by the end of March. Better funding for services and an urgent resolution to industrial action is vital to ensure the NHS can get through this winter and beyond.”

Sarah Woolnough, chief executive of the King’s Fund, said: “The NHS is still not meeting the majority of its most important performance targets this winter … Patients are still not receiving an acceptable level of service.

“To end this cycle of poor performance, the government must make long-term decisions to put the service back on track year-round. This includes making health and care a more attractive place to build a career, bolstering out-of-hospital care such as primary, community and social care services.