Usher Institute

Treatment boost needed to shift NHS Covid backlog

The NHS needs 10% monthly increase in non-emergency treatments to tackle pandemic-induced backlog, reveals analysis.

Three surgeons in operating theatre with table of instruments

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

Experts say the build-up of cases will not be cleared before the end of 2025 even if capacity is increased by the 30 per cent compared to pre-pandemic levels outlined in NHS England’s recovery plan.

Rising backlog

In the early stages of the pandemic, the NHS was forced to postpone elective, or non-urgent, treatments to focus resource on patients seriously unwell with Covid-19. This has led to a backlog of people waiting to receive care, with many requiring several referrals for multiple conditions.

To estimate the extent of disruption, researchers from the Universities of Edinburgh and Strathclyde looked at the number of referrals waiting to be treated each month in England, from January 2012 to October 2022.

The waiting list rose from 2.4 million in January 2012 to 4.6 million at the start of the pandemic in February 2020, increasing by about 275,000 referrals per year. This steady rise suggests the service was already gradually declining before the pandemic.

Pandemic disruption

Covid-19 then intensified the decline, researchers say. By October 2022, there were more than 7.2 million referrals waiting to receive non-urgent treatment.

Experts warn this is likely to be a substantial under-estimate of the backlog because of the anticipated large numbers of people yet to come forward for care following the pandemic.

An estimated 10.2 million fewer referrals were made to elective care from the beginning of the pandemic to 31 October 2022, according to the study.

Returning patients

How many of these missing patients return for care is one of the biggest unknowns when predicting future waiting list numbers.

The research team simulated a range of scenarios based on between 25 per cent and 75 per cent of missing patients seeking health care. This allowed scientists to model the outcome of several increases in capacity on waiting list numbers.

The findings illustrate the importance of resilience within the healthcare system to minimise the impact of any future emergencies on the provision of routine care, researchers say.

The healthcare system was struggling to keep up with the demand many years before the pandemic and the COVID-19 pandemic only aggravated the problem. Moving ahead, it is evident that we cannot afford to leave our healthcare systems strained; instead, we must enhance their resilience to ensure better preparedness for any future emergencies.

Dr Syed Ahmar ShahChancellor's Fellow and Senior Research Fellow, Usher Institute

Further information

Read the research letter in The Lancet

Image credit: stefanamer via Getty Images