The NHS waiting list for routine hospital treatment in England has hit another record high, official data revealed today as hospital bosses warned the Covid backlog will not be cleared for another five years.
A total of 5.7million people were waiting for elective surgery at the end of August 2021, including almost 10,000 patients who have been in the queue for two years, according to the latest figures from NHS England.
This is the highest number since official records began in August 2007 and the tenth time the milestone has been broken during the pandemic.
Prior to the Covid crisis, the waiting list stood at around 4.45million. It includes people waiting for operations like knee, hip and joint replacements, as well as cataracts surgery.
The figures also show 5,000 people waited 12 or more hours in A&E before being seen by a doctor in September, which was also the highest number on record.
Waiting lists spiralled after coronavirus forced hospitals to cancel routine operations and turn over entire wards to patients suffering from the disease at the start of the crisis last spring. Social distancing and other Covid precautions have made it more difficult to chip away at the backlog.
But the record-breaking figures come before the busiest time of the year for hospitals, with health bosses fearing the UK will be hit with a double-whammy of rising Covid case numbers and flu this winter.
England’s Chief Medical Officer Professor Chris Whitty this morning said the winter would be ‘exceptionally difficult for the NHS’.
It comes as a survey of NHS trust leaders, carried out by NHS Providers, revealed a third of bosses believe the Covid backlog will take between three and five years to clear.
With waiting lists already at their highest ever, some 96 per cent of bosses said demand is significantly rising, with mental health, urgent and emergency care and cancer services topping their worries.
The number of patients waiting for routine hospital treatment hit 5.6million in July, the highest figure since records began in 2007. And health chiefs have warned the backlog is going to get much worse before it gets better, with projections that it could soar up to 13million by the end of the year if no action is taken
More than 5,000 people waited more than 12 hours in A&E before being seen by a doctor in September, a record high
Professor Stephen Powis, NHS national medical director, said the health service has ‘moved heaven and earth’ to meet patient demand during its busiest September on record.
Meanwhile Health Secretary Sajid Javid last night unveiled a nine-point plan to address the drop-off of in-person GP consultations, which includes naming and shaming if they fail to deliver enough face-to-face appointments.
Professor Whitty today said GPs would be ‘at the forefront’ of the NHS’s response to the impending winter surge in demand while speaking at the Royal College of GPs conference.
The total number of people admitted for routine treatment in hospitals in England in August 2021 was 232,140 — up 49 per cent from a year earlier (155,789), although this reflects lower-than-usual figures for August 2020, which were affected by the first wave of the pandemic.
The equivalent figure for August 2019, a non-pandemic year, was 275,267.
The data shows a total of 9,754 people in England were waiting more than two years to start routine hospital treatment at the end of August 2021.
This is up from 7,980 at the end of July, and is more than three times the 2,722 people who were waiting longer than two years in April.
NHS England has told hospitals to eliminate all waits of more than two years by March 2022.
The number of people having to wait more than 52 weeks to start treatment stood at 292,138 in August 2021, down slightly from 293,102 in the previous month, but more than double the number waiting a year earlier, in August 2020, which was 111,026.
Meanwhile, nearly 370,000 patients in England had been waiting more than six weeks for a key diagnostic test in August. This includes MRI scans, non-obstetric ultrasounds or gastroscopies.
The equivalent number waiting for more than six weeks in August 2020 was 472,517, while pre-pandemic in August 2019 there were 42,926.
Dr Tim Cooksley, president of the Society for Acute Medicine, said: ‘This data presents a worrying picture as we are moving further away from an NHS that can provide the best possible care to all who need it promptly and closer to one which can only focus on those most critically unwell.
‘Even then it is with a threadbare workforce that has been run into the ground and there is widespread concern about winter given the NHS was in a weak position heading into the pandemic and is now rebuilding on the back foot.
‘There is no doubt this raises safety concerns and, sadly, many people will be waiting longer for their care and it will not be delivered to the standards they should expect as services struggle to contend with workload.
‘The short-term aim must be to focus on those things we know can make a difference and acute medicine is integral to both the front and back door of hospitals, so the workforce must be recognised and championed.’
He added: ‘Acute medicine has always been at the forefront when it comes to developing innovative models of care that improve outcomes and experience for acutely unwell medical patients and we are particularly focused on ensuring same day emergency care is utilised to its full potential.
‘This is a way of delivering quality and efficient patient care while improving flow and capacity, as we know from our own audit data, and it is essential this is supported from the top.’
The number of GP appointments taking place face-to-face tumbled at the start of the pandemic when surgeries were told to see patients remotely where possible. But despite vaccination rates it is yet to climb back to pre-pandemic levels. The above graph shows the number of face-to-face GP appointments (red line) by month since the end of 2019
Tracey Loftis, head of policy and public affairs at Versus Arthritis said: ‘People with arthritis’ lives are being destroyed as they languish on waiting lists.
‘Those who desperately wait to receive treatment are paying the price both physically and financially, with many being left in agonising pain, unable to work or leave their homes.
‘A total hip replacement is one of the most effective treatments on offer to improve someone’s quality of life and mobility. We have an operation that works brilliantly and yet people with arthritis face the uncertainty of long waits to access them.
‘We need to see the Government tackle the surgery backlog and that means protected funding to bring down the numbers waiting for joint replacements.
‘But people still won’t get treatment overnight, so we must also see a commitment to provide urgent support for the hundreds of thousands of people with arthritis awaiting surgery.’
NHS England figures show 210,931 urgent cancer referrals were made by GPs in England in August, up 24 per cent from the 170,036 reported in August last year.
The equivalent figure for August 2019, a non-pandemic year, was 200,317.
Urgent referrals where breast cancer symptoms were present — though not initially suspected — were up from 9,486 in August last year to 11,179 in August 2021.
Minesh Patel, head of policy at Macmillan Cancer Support, said: ‘It is disappointing to see a setback in referrals and lack of further progress in treatment numbers compared to last month and there is clearly still a lot of work to be done to get cancer services back on track and tackle the backlog.
‘The Government must urgently provide the long-term investment needed to grow and support the cancer workforce, which was severely overstretched even before the pandemic.
‘This is vital to ensuring the NHS is equipped to manage the ongoing challenges of Covid and provide patients with the care they need.’
A&E attendances at hospitals in England last month were 26 per cent higher than a year ago, NHS England said — although again this is a reflection of lower-than-usual numbers for September 2020, which were affected by the pandemic.
A total of 2.1million attendances were recorded in September 2021, up from 1.7million in September 2020. The equivalent figure for September 2019, a non-pandemic year, was 2.1million.
Nuffield Trust deputy director of research Sarah Scobie said: ‘The unfolding situation in urgent and emergency care services is troubling, and the deterioration of performance does not seem to be slowing. A quarter of all A&E patients were not seen within the four-hour target in September 2021, which is the worst performance on record.
‘With the number of patients seeking care at A&E units back to pre-pandemic levels, we see severe bottlenecks for this route into the health and care system, amid ongoing demand from Covid, and an increase in colds and respiratory illnesses.’
She continued: ‘NHS staff cannot keep up with demand, with staff absences playing a part increasingly steadily throughout September – there were an average of over 73,500 staff absent in the last week of September.
‘At this point, staff will be gearing up for a very difficult time ahead, given waits traditionally lengthen in the winter period.’
Experts said waiting lists are climbing to their highest levels ‘not seen since the waiting times crisis in the 1990s’. More than 50,000 people were waiting more than a year for hospital treatment in 1999 before the Government ploughed money into the health service to reduce waiting times.
Siva Anandaciva, chief analyst at the King’s Fund thinktank said: ‘Today’s figures show the NHS is fighting battles on multiple fronts.
‘Waiting lists for planned hospital care continue to climb towards levels not seen since the waiting times crisis in the 1990s, with the number of people on the list now reaching 5.7million and almost 10,000 people waiting over two years.
‘With the full impact of winter still to come we are already seeing record lows in A&E performance. Despite a target to see 95 per cent of people within four hours, a quarter of patients are waiting longer than that.
‘After years of under-investment, the cost of tackling the backlog of maintenance issues with NHS buildings and equipment now stands at over £9.2billion, a substantial proportion of which need urgent action to avoid harm to staff and patients.’
He continued: ‘The government has announced significant, additional funding to support NHS services, but hasn’t yet delivered on promises to increase capital investment in buildings and equipment, or provided the funding required to train and develop the staff needed to address chronic workforce shortages.
‘The Spending Review later this month is the opportunity to put that right, or risk undermining efforts to reduce the waiting list backlog, modernise services and deliver the government’s manifesto commitments.’
The NHS said it has experienced its busiest September on record, contributing to the record A&E waiting times.
An NHS England spokesperson said the health service did a third more operations in August than in the same month last year, despite dealing with 14 times more patients.
Professor Powis said: ‘There is no doubt the NHS is running hot, with the highest ever number of patients seen in A&E in September, 14-times as many Covid patients in hospital compared to the same month last year and a record 999 ambulance calls.
‘But despite the busiest September on record, NHS staff have moved heaven and earth to make the best possible use of additional investment delivering millions more tests, checks, treatments and operations.
‘That is why it is really important people do not delay seeking help from the NHS if they feel unwell.
‘Anyone needing help should come forward through 111 online so that staff can help you with the best option for your care, and it remains as important as ever to get your lifesaving Covid jab, and with winter approaching, to get your flu jab too.’
NHS figures also show a reduction in the number of patients waiting for a diagnostic scan for the first time this year, meaning more people are now getting the checks they need. This follows the rollout of NHS diagnostic centres last month which were backed by fresh funding to help the NHS to tackle the backlog.
Ambulances responded to a record 76,000 life threatening call-outs, an increase of more than 20,000 on the previous high for September, while 999 took nearly one million calls in September.
NHS 111 also saw record demand taking a call every 7 seconds and over 1.9million calls in total across August. The NHS has invested an additional £23 million into NHS 111 to help the service meet the increased demand.
Deputy chief executive of NHS Providers, Saffron Cordery said: ‘Today’s figures demonstrate the extremely challenging position trusts are in as we head into winter.
‘Ambulances are under incredible strain, with demand amongst the most seriously ill patients rising by a staggering 37 per cent compared to before the Covid pandemic.
‘This pressure is being felt across urgent and emergency care. There are worrying delays for patients, with over 5,000 people waiting over 12 hours to be admitted into hospital. Referrals for mental health services are far higher than they were before the pandemic and demand for community services continues to be a major concern.
‘However, it is important to recognise the professionalism and commitment of NHS staff, who have given so much through the pandemic and are working hard for patients in these exceptionally difficult circumstances.
‘Waiting lists for planned surgery have reached a new high of 5.7 million but there are hopeful signs this rise is starting to plateau, and there is some evidence of progress in bearing down on the longest waits, alongside the focus on the most urgent cases.