15 February 2022
It was reported that over 6 million people were on a waiting list for NHS treatment in December 2021, an increase of around a third since Covid-19 hit. In a bid to tackle this, the government has announced an ambitious Elective Recovery Plan. But what is the outlook for waiting lists in the coming years?
The NHS plan, which was supposed to be published in December, was thought to have faced delays due to friction between the Sajid David and the treasury about funding; though this is something the health secretary denies. Matthew Taylor, Chief Executive of the NHS Confederation expressed concern that healthcare funding plans could face setbacks if the Treasury viewed expenditure as “wasted on a dying institution.”
But the health secretary was keen to express his close relationship with the treasury and blamed Omicron as the key factor in delays to the plan. Javid told Sky News, “I had planned to publish the plan in December. We were almost there, we were agreeing it finally with the NHS and across government, but because of Omicron we’ve rightly changed our focus, especially to boosters and to focus on that.”
Published on February 8th, the plan sets out ambitions rather than targets of how it intends to handle the huge impact of the pandemic on UK public healthcare. One of the main ambitions is that the NHS will carry out 30% more elective activity than before Covid-19 by 2024-25. The Institute for Fiscal Studies sets out what an ambitious aim this is by looking at the levels of growth historically. They found, “Over the three years between 2016−17 and 2019−20, the number of people receiving treatment from the waiting list increased by just 4.3% (over the five years to 2019−20, the number grew by 14.8%).” Taking this into account and the fact that funding for the NHS has not increased from what was announced last year, reveals the scale of the task ahead.
The government plan acknowledges that waiting times aren’t likely to fall until 2024. However, even this remains a big unknown given the estimated 8 million ‘missing’ patients (those who have missed care during the pandemic) that are yet to come forward. The problem is that it’s almost impossible to estimate just how many of these missing patients will materialise and therefore what to expect for waiting lists. There is little evidence to understand how many of the patients who missed care over the pandemic are returning to get treatment now.
Looking at the below graph from the Institute for Fiscal Studies reveals the level of uncertainty about waiting lists moving forward. The study uses the assumption that the NHS manages to achieve it’s 30% increase in elective activity and the low, middle and high estimates reflect how many ‘missing’ patients return to seek care. Plan Low assumes 30%, Plan Middle 50% and Plan High 80% of patients return. The NHS plan implied that they expected a minimum of 50% to return, so taking a look at the Plan Middle line as a conservative estimate sees waiting lists peak at 8.7 million in October 2023.
While there remains huge unknowns about the future of NHS waiting lists, what’s inevitable is that numbers will get worse before they can get better. With treatments affected by Omicron over the winter while new patients join the waiting list, it’s evident that there’s a long road ahead for the NHS to begin recovering from Covid-19.
