Without a radical intervention to increase capacity across the NHS in England, it is unrealistic to expect the 18-week standard for elective waiting times to be achieved by 2024 with current infrastructure and staffing levels. This is the conclusion of a new report from The Health Foundation, ‘Elective care in England: Assessing the impact of COVID-19 and where next’.
The long read uses routine data on 18-week waiting times for consultant-led elective care. It states that to meet the 18-week standard would require hospitals to increase the number of patients they admit by an amount equivalent to 12% of all the patients admitted for planned care in 2017/18. This would be an unprecedented increase in activity.
This is without factoring in further delays to treatment as a result of COVID-19 as cancellation of planned elective activity continues at some Trusts that are already being severely impacted by high levels of admissions to the second wave of the coronavirus.
The rates spending growth allocated in the NHS Funding Bill in February 2020 will also be inadequate. The Health Foundation estimates that spending growth would need to increase by a further £560m a year – and that’s assuming the NHS can prioritise patients to make the most effective use of available capacity.
Long-term changes to the delivery of routine care are going to be necessary, including the independent sector playing an “important role”. Even then, the reality is that longer waiting times for planned care are here to stay for the NHS in England for at least several years.
Other steps include expanding the use of remote consultations, considering more effective ways of using existing capacity – such as undertaking diagnostic work in dedicated hubs outside of hospitals – and consolidating treatment services, perhaps in regional centres.
However, predicting how much waiting lists will continue to grow and how long it will take to clear the backlogs are likely to remain unclear. One thing that is clear is that to recover from the disruption caused by COVID-19 will require substantial increases in hospital activity – to keep up with demand from new patients added to waiting lists as well as to clear the backlog.