New figures suggest that one in six people will be on an NHS waiting list by April following pandemic disruption to elective care and treatment referrals, as NHS trusts are urged to utilise the private sector to meet unprecedented demand.  

The new data modelling, from think tank Reform and Edge Health, reveals that there were six million fewer referrals to treatment last year as the NHS essentially became a “National Covid Service”. By April, 52 week waits for treatments will have risen 12,008 per cent since March 2020.  

Tragically, for lung cancer alone 1,660 premature deaths are expected due to delayed diagnosis and treatment, the paper predicts. 

The report: What next for the NHS, makes projections based upon the proportion of ‘missing activity’ that is set to return in the next few months and calculating capacity restrictions upon health services due to infection prevention measures. The report states that a lack of resilience forced the NHS to become a ‘National Covid Service’, causing unprecedented backlogs and delays while staff mounted heroic efforts to tack the pressures of the pandemic.  

The modelling projects that waiting lists could hit 10 million by April, equivalent to one in six in England, as referrals for non-Covid begin to restart while pandemic pressure and infection prevention measures still limit NHS capacity.  

The report also argues that the private sector has not been effectively utilised throughout the pandemic to deliver non-Covid care, despite instruction from NHS England for local health leaders to refer patients there.  

The report urges NHS England to mandate the publication of “waiting list recovery plans” by NHS trusts, which clearly state how independent sector capacity will be used.   

The report goes as far as to say that trusts are being negligent if trusts are not currently utilising the independent sector for capacity and resources, such as MRI machines and other equipment.

The report also takes aim at a recent proposal from the NHS Confederation to urgently increase acute care bed capacity, stating that resource should instead be found in the private sector. 

Community diagnostic centres for cancer, cardiac and other conditions should be set up to restart screening programmes halted by the pandemic, the report says. This should also be coupled with a renewed focus on prioritising those most urgently in need of care currently on waiting lists.  

The think tank is concerned that the Health and Social Care White Paper brought forward last week by the Health Secretary, does not address the ballooning waitlist or the need to boost capacity and resources to make the Service more resilient. 

“Never again” 

Eleonora Harwich, Director of Research at Reform and report Co-Author, said: “We must never have the equivalent of a ‘National Covid Service’ again.  

“This is a system problem and in no way detracts from the heroic effort of NHS staff battling Covid-19. However, the cessation of so much non-Covid care means patients are facing more serious health conditions or disabilities, and some will die prematurely.” 

George Batchelor, Director of Edge Health, also commented, saying: “The ferocity of the pandemic was met with tremendous bravery but came at a cost to normal NHS services, which in many areas were struggling before the pandemic. The full scale of this cost has not yet been seen, but the backlog is already ballooning and will get much worse in coming months.”  

“The short-term recovery of NHS staff will jar with the need to manage the backlog. But perhaps a bigger challenge will be how to balance the recovery while also building greater long-term resilience and preparedness for the future.”  

Reform recognises that chronic issues around funding, workforce, and data quality created barriers to the pandemic response. 

The report is calling on Ministers to address these structural issues in order to better respond to future crises, including any further waves of hospitalisation due to Covid. 

Figures suggest 141,808 worth of hospital bed-days could have been freed up during the April 2020 peak, had delayed discharges and hospital overstays been avoided.  

The think tank points to lacking capacity in social and community care as the primary reason for discharge delays and is calling for funding to improve capacity in non-hospital settings to reduce any delays in patients being discharged out of hospital. 

To rapidly expand workforce capacity in the event of another crisis, the think tank is calling for a new ‘NHS reserve list’ of healthcare professionals willing to re-join, including regularly updated training to maintain up to date skills. 

Responding to the report, NHS Confederation Director of Policy Layla McCay disputed the assertion that the NHS has become a “Covid only service” and also insisted that increasing bed capacity in the acute sector remained a “vital” option. She said: “despite these challenges, it is plainly not the case that the NHS has been a Covid-only service. In December and January alone, the NHS in England performed over six million elective operations, treated over 280,400 people for cancer, and supported over 18.8 million admissions into A&E.” 
“Although cases of coronavirus are continuing to decline, the threat of future waves remain, and experts are clear the disease will never go away completely. Increasing acute bed capacity is vital but it is far from being the only solution. As we explained in our letter to the Prime Minister last week, a long-term plan to grow the NHS workforce is needed too, as well as additional investment in community, primary, ambulance and mental healthcare. And we finally need a solution to end the crisis in social care.” 

Download the full report here.