One year on from the publication of the NHS elective recovery plan, the IFS has warned that waiting lists are unlikely to fall this year.

New analysis from the Institute for Fiscal Studies (IFS) has found that NHS waiting times targets are unable to be met this year, and that overall waiting lists are likely to flatline in 2023 before finally falling in 2024.

The NHS Elective Recovery Plan was published in February 2022 as the health service began to recover from Covid-19. Its headline ambition was the aim to increase NHS elective activity to 30 per cent above pre-pandemic levels by 2024-25. Also covered in the plan were targets to eliminate waits of more than two years for treatment by July 2022, one-and-a-half-year waits by April 2023, and to reduce waiting times for diagnostic tests, cancer referrals and outpatient appointments.

Although the IFS notes good progress on certain metrics, such as the two-year wait target, the overall elective waiting list grew to 7.2 million incomplete pathways by November 2022. The IFS is now warning that the backlog may not begin to recede until 2024, “due to the lingering effects of Covid-19 and other pressures on the system.”

Although the NHS did treat more patients in November 2022 (1.55 million) than it did in December 2019 (1.48 million) – a result of “steady, if modest, increases in treatment volumes since July” 2022, according to the report – the IFS analysis shows that between January and November 2022, “the NHS treated 6.6 per cent fewer patients from the waiting list” than in the same period in 2019.

To achieve its target of achieving a 30 per cent increase in elective activity by 2024-25, the NHS is seeking to make use of more non-hospital treatment pathways, such as increasing the usage of advice and guidance services. This allows GPs to liaise with consultants before, or instead of, a hospital referral, with the aim of reducing overall referrals to secondary care. These requests have increased from 42,700 in January 2019 to 114,000 in December 2022, a 167 per cent increase.

As such, after accounting for the increase in guidance and advice services, the IFS has calculated that in order to reach its targets by 2024-25, overall elective activity levels will need to increase by 20.9 per cent.

Taking average treatment volumes from September-November 2022 (97 per cent of 2019 levels) as a starting point, the NHS would need to increase treatment volumes by 10.3 per cent annually between now and March 2025. The IFS describe this as “an incredibly high growth rate”, especially considering that between February 2015 and February 2020, treatment volumes grew by an average of 2.9 per cent annually.

Tackling long waits

As set out by the NHS Constitution for England, 92 per cent of patients should wait no longer than 18 weeks from referral to treatment, but NHS figures show that this target was met in just 58 per cent of cases in December 2022, falling from 60.1 per cent the previous month.

The Recovery Plan also included the ambition of eliminating waits of more than two years for NHS treatment by July 2022, something that has largely been achieved, if slightly behind schedule; the number of people waiting for more than two years for treatment fell from 23,300 in February 2022 to 1,400 in November 2022, a 93.9 per cent reduction.

NHS Providers Chief Executive, Sir Julian Hartley, commented: “Trust leaders and their staff have made significant progress in reducing long waits for patients, which is remarkable given the challenging circumstances in which they’re operating. Their success in virtually eliminating two-year waits for elective care and being on track to bring down 18-month waits by April is testament to the hard work of frontline teams.

“Despite progress around two-year waits, however, overall numbers for other target groups have continued to grow. The ambition to eliminate 1.5-2 year waits by April 2023 looks unlikely to be met, with this group growing by 7.4 between January and September 2022 (45,200 to 48,500, respectively.

The total number of people waiting for more than a year to receive treatment also grew during 2022, rising from 300,000 people in February to 410,000 by November. This figure stood at a mere 1,845 in February 2020, and according to the IFS, “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.”

Responding to the IFS’ findings, Saffron Cordery, the Deputy Chief Executive of NHS Providers, said: “This has been one of the toughest winters for the NHS, but the hard work of trust leaders and their staff is leading to promising results. Despite demand for urgent and emergency care services remaining very high, ambulance response times have improved considerably.

“However, we’re still not in the clear: waits of 18 months or more have gone up, and trust leaders are deeply concerned that other pressures – including staff shortages and escalating strikes – could not only obstruct future gains but derail ones already made.”

Tim Gardner, Senior Policy Fellow at the Health Foundation, said: “There were 7.2 million people waiting for routine hospital treatment at last count, up from 6 million a year ago. Behind these numbers are patients left in pain, and people enduring unnecessary suffering. The public and government must be under no illusion: there is still a significant mountain to climb before waiting lists are back to a more acceptable level.”