Millions of people have avoided seeking or been unable to obtain referrals for healthcare during the Covid-19 pandemic, this is according to new analysis from the National Audit Office (NAO).

The NAO estimates that between March 2020 and September 2021 – there were between 7.6 million and 9.1 million fewer referrals for elective care. 

The NAO also estimates that there were between 240,000 and 740,000 “missing” urgent GP referrals for suspected cancer during the pandemic. In addition, it is estimated that up to September 2021 between 35,000 and 60,000 fewer people started treatment for cancer than would have been expected.

The report claims there is a real risk that the waiting list for patients seeking elective care will be longer in 2025 than it is today. The NAO predict that if 50 per cent of “missing” referrals for elective care return to the NHS and its activity grows only in line with pre-pandemic plans, the elective care waiting list will reach 12 million by March 2025. If 50 per cent of “missing” referrals return and the NHS can increase activity by 10 per cent more than was planned, the waiting list in March 2025 will still be seven million.

Commenting on the report, Ruth Thorlby Assistant Director of Policy at the Health Foundation, said: “The NAO’s report has delivered a cold dose of reality about the scale of the challenge facing the NHS in the years ahead. Even before the new Covid variant emerged, the NAO warns that the record-breaking waiting lists could grow even bigger before they improve. Any more disruption risks making the mountain to climb that much higher. 

“Given the huge uncertainty, the government’s NHS recovery plan needs to be realistic about the complexity of bringing waiting lists down and how long it may take to do so.”

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. Increasing 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.

Responding to the report, Deputy Chief Executive of NHS Providers, Saffron Cordery said: “Trusts and frontline staff are working incredibly hard to bear down on this backlog- and progress is being made but this report highlights the sheer difficulty in trying to predict how long a full recovery will take.

“We are also faced with ongoing uncertainty over how many people will continue to come forward for care, the number of hospital admissions due to COVID-19 hospitalisations in the future, particularly given the threat of Omicron, and how quickly we can stabilise the urgent and emergency care pathway.”