HEALTHCAR E DE LIVE RY
National audit highlights extent of NHS pressures
A new report by the National Audit Office has warned that there is a significant risk that NHS waiting times could lengthen even further and provides a detailed analysis of the challenges ahead.
Recovering elective and cancer care performance to the standards required will be a huge and lengthy challenge for the NHS, and there is a real risk that the waiting list for patients seeking elective care will be longer in 2025 than it is today, according to analysis from the National Audit Office (NAO).1
The Government is providing the NHS in England with an additional £8 billion between 2022-23 and 2024-25 to support the recovery of elective care. With the extra funding, it expects the NHS to increase elective care activity by 2024-25 by 10% more than its pre-pandemic plans. Before the COVID-19 pandemic, the NHS was doing more work year-on-year, but demand for its services was increasing even faster. Between 2010 and 2019, NHS resources changed unevenly: the number of consultants grew at over 3% a year, but there was almost no change in nurse numbers, and there was an annual 1.1% reduction in the number of general and acute care (non-critical care) beds available for overnight use. To keep pace with the demand for its services, the NHS would have needed either more beds and more staff or a different way of working, or a combination of the two.
Performance against NHS waiting times standards had generally been deteriorating prior to the COVID-19 pandemic. The main standard for elective care is that 92% of patients on the waiting list should start their treatment within 18 weeks of being referred to a consultant. In February 2020 – the last month before the impact of the pandemic was felt – 17% of elective care patients had
Underinvestment in NHS equipment and facilities and the lack of long-term planning on staffing and training meant the UK’s health service went into this crisis with fewer beds and staff than many other international systems. It is these constraints going in that will slow the
NHS’s path to recovery. John Appleby, director of research, Nuffield Trust.
JANUARY 2022
been waiting for longer than 18 weeks. There are nine waiting time standards for cancer care, including a standard that 85% of patients should wait no more than 62 days to start treatment after an urgent referral by a GP. Between August 2018 and February 2020, 22% of people had to wait for more than 62 days. Since the start of the COVID-19 pandemic, the NHS has had to redirect much of its resources to treat COVID-19 patients and to implement infection, prevention and control measures. In January 2021, an average of 24,100 general and acute care beds were being used by COVID-19 patients (31% of all those occupied). Between January and September 2021, an average of 35% of unoccupied general and acute care beds had to be set aside for COVID-19 patients.
COVID-19 disruption was inevitably going to cause a sharp increase in waiting times and backlogs in a healthcare system that had been operating at very close to its maximum capacity. By September 2021, there were
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