NHS waiting list likely to ‘flatline’ for the next year, economists warn

Waiting list of longer than a year would be gone by March 2025, says think-tank

The NHS waiting list is likely to “more or less flatline for the next year”, risking the ambitions of the Government and NHS England, a think tank has said.

The Institute for Fiscal Studies (IFS) warned that, while some progress has been made in cutting long waits for treatment, plans to cut the overall waiting list and substantially increase the number of people getting help are unlikely to happen this year.

The elective recovery plan published by NHS England a year ago said the NHS would eliminate waits of more than two years for treatment by July 2022.

It said waits of longer than a year would be gone by March 2025, while waits of more than 18 months would be ended by April 2023.

The plan also said the NHS would deliver around 30 per cent more elective activity (treatments planned in advance) by 2024/25 than before the pandemic.

The overall NHS waiting list currently stands at 7.2 million people.

In a new report, economic experts from the IFS said the NHS has made good progress on some of these aims, with the number of people waiting more than two years falling by 94 per cent between February and November last year.

However, it said the number of people waiting 18 months to two years actually grew by 7 per cent up to September, adding: “Similarly, the number of people waiting between 1.25 and 1.5 years increased from 86,000 in February 2022 to 115,300 in September 2022, an increase of 34% per cent”

The number of people waiting more than a year for treatment also rose from 300,000 in February to 410,000 in November, a 36 per cent increase, the IFS said.

Prior to the pandemic, this latter number “was effectively zero”.

(The NHS) can only prioritise reducing some groups, such as those waiting more than two years, while other parts of the waiting list continue to grow

Institute for Fiscal Studies

The IFS said the fact that such numbers continue to grow “illustrates the broader challenge: while waiting lists are continuing to grow overall, it is not mathematically possible for the NHS to reduce the number of people waiting for all time periods.

“Instead, it can only prioritise reducing some groups, such as those waiting more than two years, while other parts of the waiting list continue to grow.”

The IFS further looked at the ambition to increase treatment volumes to 30 per cent above pre-pandemic levels by 2024/25.

“As it stands, our judgment is that this is highly unlikely to be achieved – not least due to the lingering effects of Covid-19 and other pressures on the system,” it said.

“As a result, waiting lists are – in our view – unlikely to start falling rapidly any time soon. Instead, our central expectation is that waiting lists will more or less flatline over the next year, and fall only gradually from mid-2024.”

It remains the case that the NHS has struggled to make any meaningful progress against its headline target of increasing elective activity by 2024/25 to 30 per cent above pre-pandemic levels

Institute for Fiscal Studies

The IFS said that for waiting lists to start falling meaningfully this year “as the Prime Minister has all but promised”, one of two things would need to happen.

“One, the NHS achieves a truly remarkable increase in how many patients it manages to treat.

“Or two, the number of people joining the waiting list for treatment stays unexpectedly low – whether because they do not think they need NHS care or because they are unable to access it.”

The report said that, between January and November last year, the NHS actually treated 7 per cent fewer patients from the waiting list than it did over the same period in 2019.

While progress since then has been encouraging, with the NHS treating 1.55 million patients from the waiting list in November 2022 compared with 1.48 million in November 2019, “it remains the case that the NHS has struggled to make any meaningful progress against its headline target of increasing elective activity by 2024/25 to 30 per cent above pre-pandemic levels”.

Mounting pressures on acute, ambulance, mental health and community services, such as chronic workforce shortages, could hamper efforts to cut the backlog further if left unchecked

Sir Julian Hartley, NHS Providers

Max Warner, research economist at the IFS and an author of the report, said: “To its credit, the NHS has made real progress in its efforts to reduce the number of patients waiting a very long time for care, virtually eliminating waits for care of two years or more.

“But efforts to increase treatment volumes have so far been considerably less successful…

‘To turn things around, and deliver on the headline ambition of increasing elective activity to 30 per cent above pre-pandemic levels by 2024/25, would require unprecedented double-digit growth in treatment volumes over the next two years.

“That would be more than three times the growth rate in the five years prior to Covid, and looks increasingly unreachable. As a result, it is likely that the waiting list will flatline rather than fall over the coming year.”

A fully-funded workforce plan from the Government will go a long way to help

Sir Julian Hartley, NHS Providers

It comes as NHS England said hundreds of thousands more patients will get treatment next year thanks to new surgical hubs.

It estimates 780,000 more surgeries and outpatient appointments will be provided at 37 new surgical hubs, 10 expanded existing hubs and 81 new theatres dedicated to planned care.

Responding to the IFS report, NHS Providers chief executive Sir Julian Hartley said “mounting pressures on acute, ambulance, mental health and community services, such as chronic workforce shortages, could hamper efforts to cut the backlog further if left unchecked”.

He added: “A fully-funded workforce plan from the Government will go a long way to help with this and ensure recovery is sustainable.”

Shadow health secretary Wes Streeting said: “In the biggest crisis in the history of the NHS, Rishi Sunak is threatening universities with fines if they train more doctors. His refusal to negotiate with nurses is prolonging disruptive strikes.

“The longer we give the Conservatives, the longer patients will wait.”