Light amongst the dark? NHS capacity improves, but waiting times increasing

For the purposes of this article, we have analysed NHS England RTT waiting times for patients as of December 2022 - the most recent month for which this data is available at the time of writing.

In the last few weeks, NHS England has released data showing that capacity for elective activity is gradually returning to pre-Covid levels, with some NHS hospital trusts turning over greater volumes of elective treatment (necessary but non-emergency) than before Covid-19. Despite this, waiting times for treatment remain high, with patients waiting an average of 6 weeks longer for treatment compared to December 2019.¹ Therefore, while the supply of NHS services is returning to pre-Covid levels, this has not yet been enough to address increases in demand. A lot more needs to be done to reduce the NHS backlog, and return waiting times to their previous levels.

Taking 2019/20 as the pre-Covid baseline for the number of patients receiving elective care, data shows that on a national basis, the NHS briefly returned to its pre-Covid capacity for elective care (as of November 2022). However, this did not persist into December, despite controlling for seasonality effects.

Yet, there is significant variation between NHS trusts. Taking a selection of NHS hospital trusts in London, we can see that some NHS providers, such as Imperial College Healthcare Trust, have managed to accelerate the provision of elective treatment. By doing so, they are now trearing more patients than before the pandemic. On the other end of the scale, Royal Free London - which runs a number of London hospitals - is operating at almost half its pre-Covid volume (December 2022 versus December 2019). Sadly, these underpermers appear to be bringing down the region. As a whole, London appears to be lagging behind the rest of the country. It is continuing to perform at reduced levels for elective care, relative to both England and London’s own pre-Covid baseline.

Perhaps most importantly though, this has not been reflected in waiting times, at least when compared to the rest of England. Looking at the average (median) time that patients have been waiting for consultant-led, non-emergency care, all five of London’s sub-ICBs (effectively localised NHS divisions) are below the national average of 14.4 weeks. Of the five sub-ICBs, South West London has the lowest median wait for patients still on the waiting list, at 11.5 weeks as of December 2022.

Nevertheless, such waiting times, in London and across the country, are significantly higher than before the pandemic. In December 2019, the national average time a person had been waiting for elective care was around 8 weeks, a full 6 weeks shorter than in late 2022. Importantly, this upward trend has seen no concerted reversal, indicating that the gradual return of NHS capacity has done little to dent the record demand, and subsequent waiting times, facing the NHS.

This is reflected by the number of patients on elective-care NHS waiting lists, which appears to be consistently hovering around the 7 million mark, with no clear indication it will be reducing any time soon. For instance, after a net reduction of 30’000 over November 2022, there was a dramatic reversal, as the net number of patients waiting for treatment subsequently increased by more than 80’000 in the following month. This is perhaps unsurprising in the context of reduced elective activity in December 2022, as discussed above, but it is still nevertheless concerning.

Detailed analysis by the Institute for Fiscal Studies suggests that the NHS will continue to struggle to work through the backlog of patients needing treatment, with waiting lists ‘flatlining’ for at least the next year.²

Last month, NHS England announced plans to introduce specialist surgical hubs, as well as expand existing hubs, with the aim of introducing more than 750’000 surgeries over the course of the year.³ These hubs are designated as separate from theatres which can be used for emergency care, with the idea that surgery can therefore be provided on a more consistent basis, apart from fluctuations in demand for emergency care. The extent to which this can adequately combat waiting times remains to be seen. Nevertheless, it is demonstrative of the steps the NHS is taking to affect change and improve service delivery.

Sources:

Where not cited, statistics come from HealthSay’s in-house analysis of publicly available data.

1. NHS England. 2023. “Statistics » Consultant-led Referral to Treatment Waiting Times.” NHS England. https://www.england.nhs.uk/statistics/statistical-work-areas/rtt-waiting-times/.
2. Warner, Max, and Ben Zaranko. 2023. “One year on from the backlog recovery plan: what next for NHS waiting lists?” Institute for Fiscal Studies. https://ifs.org.uk/publications/one-year-backlog-recovery-plan-what-next-nhs-waiting-lists.
3. NHS England. 2023. “NHS England » Hundreds of thousands more patients to benefit from major NHS surgical capacity boost.” NHS England. https://www.england.nhs.uk/2023/02/hundreds-of-thousands-more-patients-to-benefit-from-major-nhs-surgical-capacity-boost/.