Medicine Hot Topic: NHS Care Backlog

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It’s important that you know about the state of NHS care – and that means the current care backlog. Here, we will assess what the backlog is, key figures, effect on cancer care, and what the NHS itself says about the situation.

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What is the NHS care backlog?

The backlog is an issue in secondary care, and largely is made up of care that would normally have been delivered by the NHS, but was impacted due to COVID-19. This care includes the following:
– patients who have not presented to their GP for a referral due to concerns around the state of the health service (itself a significant part of the problem)
– patients on a waiting list for treatment who would typically have been seen by now
– patients whose procedures have been cancelled
– patients whose referrals have been delayed or cancelled
– patients whose referrals have been refused due to their lack of capacity.

To clear this backlog will take years, and due to the need for greater infection control measures, added to the shortage of doctors and nurses, it’s likely that the process will be slow and difficult.

We must be aware that the care backlog is not new – even before the pandemic there were more than 4 million people on a waiting list. At the start of the pandemic, changes to the public’s behaviour, and the suspension of non-urgent services, led to the number of people being added to the waiting list actually dropping. However, this has since risen dramatically, and is now far higher than before COVID. The latest figures show:

  • 20 million people waiting for treatment;
  • 1 million of these patients waiting over 18 weeks;
  • Median waiting time for treatment of 14.4 weeks – higher than the pre-Covid median wait of 8.3 weeks in December 2019.

As well as the waiting list, there is a hidden backlog of patients who have not yet presented, or who have had their referrals cancelled due to the impact of Covid-19 on the NHS – in other words, they normally would have either been treated or already be in the system, but they are instead still outside of it.

This is causing particular problems with cancer care, with the number of patients referred having surpassed pre-pandemic levels, but the amount of patients seen by a specialist consultant within two weeks of an urgent GP referral for suspected cancer remaining very low – the target is 93% of patients are seen within two weeks of being referred, yet only 80% are being seen within this timeframe according to the latest data.

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What does the NHS say?

The NHS claims that staff have reduced the number of patients ‘waiting more than a year and a half by over a quarter in just one month, despite the busiest winter ever,’ adding that ‘the total number waiting more than 18 months has fallen by 27% from 54,382 on 15 January to 39,903 as of 12 February.’ The goal is to reduce this group of patients to zero by Q2 2023, and 10 trusts have already eliminated 18 month waits entirely, with the total number of patients waiting more than 18 months now down more than two thirds from its peak of 123,969 in September 2021. The NHS goes on to point out the risk posed by ‘record pressure this winter with the fears of a ‘twindemic’ becoming a reality– resurgent flu combined with ongoing Covid – and the highest ever levels of demand for A&E and most urgent ambulance call outs’ Additionally, bed occupancy has been very high across the winter of 2022-2023, with more than 95% beds consistently occupied, and many being taken up by patients who are otherwise fit for discharge.

The NHS also points out specific trusts that have made recent progress, like the Manchester University NHS Foundation Trust, which has brought down their longest waiters by more than a quarter (28%) in the last four weeks, from 5,287 to 3,802.

However, other organisations seem rather in contrast to the NHS’s stance – whilst the 18 month waiters may be being reduced, the backlog in the rest of the system is very much there, and very much an issue, according to the BMAT.

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