The waiting list for patients seeking elective care could be longer in 2025 than it is today, according to a new report by the National Audit Office (NAO).

The report warns that although the government has said it will provide the NHS with an extra £8 billion between 2022-23 and 2024-45 to support the recovery of elective care, demand on the NHS was rising faster than it could keep up with even before the Covid-19 pandemic.

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. There was also 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 demand for its services, the NAO state that the NHS would have needed either more beds and more staff or a different way of working, or a combination of the two.

A third of general and acute care beds set aside for Covid patients

However, when the pandemic began, the NHS had to redirect much of its resources to treat Covid patients and to implement infection, prevention and control measures. In January 2021, nearly a third (31%) of general and acute care beds were being use by Covid patients.

This meant that 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.

This inevitably led to a sharp increase in waiting times and backlogs in a healthcare system that was already operating at very close to capacity. By September 2021, there were 5.83 million patients on the waiting list for elective care, of whom 1.95 million patients had been waiting for more than 18 weeks, with 301,000 waiting for more than a year.

On top of this, NAO say there are “millions” of people who have avoided seeking diagnosis or treatment, or have been unable to obtain healthcare during the pandemic. The NAO estimate that between March 2020 and September 2021, there were between 7.6 million and 9.1 million fewer referrals for elective care.

With this, they estimate there are between 240,000 and 740,000 missing urgent GP referrals for suspected cancer, and between 35,000 and 60,000 fewer people started cancer treatment than would be expected.

The NHS will need to “significantly increase its activity” to be able to cope

The NAO say the NHS will need to significantly increase its activity to be able to cope with the surge in demand that is expected when these “missing” cases return to the NHS.

If just half of these missing referrals return to the NHS and its activity grows in line with pre-pandemic plans, the elective care waiting list will reach 12 million by March 2025. Yet, if the NHS can increase activity by more than 10% than was planned, this number drops to seven million.

They report concludes: “Addressing backlogs and reducing waiting times will be a multi-faceted challenge for the NHS. Announcements about additional funding in September and October 2021 answer some questions but important uncertainties about the road to recovery remain.

“To increase the numbers of hospital beds, nurses and doctors beyond the levels already planned could take years because of the time required for capital projects and for training. The ongoing Covid-19 pandemic could also continue to affect bed and staff availability in unexpected ways and at short notice.”