A new analysis reveals that the Government’s plan to deliver an extra 40,000 NHS appointments and operations each week will not be enough on its own to achieve the 18-week waiting time target for 92% of patients to start routine hospital treatment by the end of this parliament.
The additional appointments and operations are central to the Government’s ambition to hit this key target; a target that has not been met for nearly a decade. To deliver the extra appointments – which equate to two million a year – neighbouring hospitals will be enabled to share waiting lists, the independent sector will be commissioned to supply additional capacity and NHS staff will be incentivised to work extra evenings and weekends.
However, the new study by the NHS Confederation with healthcare consultancy CF (Carnall Farrar) has found that 40,000 extra appointments per week will only deliver an estimated 15% of the extra activity needed to hit the 18-week target if demand carries on growing in line with current trends and care continues to be delivered in the same way it is today.
More is needed
While extra capacity is a promising start, further reforms and transformation in care pathways are needed to bridge the gap. The report’s authors say this is possible, but it requires change in every step of the pathway of care. It needs both a strengthened focus on existing initiatives as well as a more radical approach to elective hubs – doubling the current capacity – and the creation of centres of expertise for complex care. Capital investment to boost infrastructure is also essential. Some of this is already in place but the measures are not being universally adopted.
The analysis has found to achieve the 18-week standard, 3.6m referrals should be managed at any one time to respond to the expected need for care and to keep the waiting list from growing further.
Other findings
In 2023/24, the NHS completed 22.2 million outpatient appointments, 2.8 million day-case procedures and 740,000 overnight stays. Without any changes to the way services are delivered, an additional 5.1 million outpatient appointments, 500,000 day-case procedures and 150,000 overnight stays would be needed this year (2024/25) simply to prevent the waiting list from increasing further. The total activity required to ‘stand still’ would therefore be 27.3 million outpatient appointments, 3.3 million day-case procedures and 890,000 overnight stays.
The NHS will also need to treat an additional 3.96 million people who are currently on the waiting list to address the one-off requirement of eradicating the backlog of people waiting. Spreading this one-off requirement over the five years would take an additional 1.1 million outpatient appointments, 120,000 day-case procedures and 36,000 overnight stays, per year.
However, demand for NHS services continues to grow at an average rate of 3.8% per year (faster than the rate of funding growth). To go beyond standing still, in 2028/29 the NHS will need to provide 33.6 million outpatient appointments, four million day-case procedures and 1.1 million overnight stays to clear the waiting list back to levels that would sustain performance against the 18-week target in 2028/29. This is 50% more activity than is now being delivered. This modelling assumes no changes to the way care is planned and delivered.
Recommendations
The report welcomes the focus on elective recovery by the new Government and calls for a more transformational approach to both clear the backlog and sustain performance at the 18-week standard.
It recommends a range of measures, including:
• Digitising waiting list management and continuously validating the patient tracking list
• Creating elective hubs for people whose treatment involves an admission to hospital
• Creating centres of expertise for complex elective admitted care
• Transformation of outpatient elective care for people who do not need a hospital admission by adopting the latest technology and innovation such as AI.
NHS Confederation Chief Executive Matthew Taylor says: “NHS leaders share the Government’s ambitions to restore performance on the 18-week target by the end of this parliament. But to achieve this the Government will need to use the Autumn Budget to deal with the short-term deficit that is leading to NHS organisations either cutting or freezing posts. This will inevitably impede efforts to increase productivity and reduce the waiting list. As our analysis with CF shows, 40,000 extra appointments a week won’t be nearly enough to hit the target.
“We also know that the Government’s intention of paying NHS staff time-and-a-half for weekend and evening shifts to clear the backlog doesn’t go beyond what many NHS Trusts are already paying. So this alone won’t cover the shortfall.
“Ultimately, we know that in order to keep up with the healthcare needs of the population the NHS needs reform, not just ever more activity. This means shifting to earlier, more preventative services – including primary and community care – to slow the rise in demand for healthcare. It will also mean boosting productivity through using modern technology and having buildings and equipment that are fit for the 21st Century. This can’t be done without further investment in capital funding, which will make every pound spent on services go further.”
