Thousands of patients are being forced to wait more than 18 months for treatments such as knee and brain surgery as the health service is set to miss its flagship target because of NHS strikes.
NHS England last week claimed it was “on track” to hit the mandated target, but senior sources have warned that the impact of prolonged walkouts combined with unprecedented demand for emergency care means that this is now unlikely.
The sources say it is probable that up to 10,000 patients will still be waiting for 18 months or more by the end of March, as a knock-on effect of the cancellation of 140,000 appointments because of strike action. More walkouts are planned over the coming weeks.
One trust leader said they feared more urgent cases could be deprioritised in a bid to clear the backlog.
Sir Julian Hartley, the chief executive of NHS Providers, which represents NHS trusts across the country, warned that leaders were “cautious” that efforts to eliminate the backlogs could be affected by the strikes and by a shortage of workers.
He urged the government to open talks with unions now over the pay offer for this financial year.
The most recent NHS data shows that 51,000 patients were waiting more than 78 weeks in December, up from 44,000 in November. However, this was down from around 140,000 the previous year.
In January, NHS leaders sent a letter to all trust directors requiring them to ensure that all patients on their 78-week waiting lists were booked for an appointment or treatment before the end of April.
One senior NHS source admitted that this would not be possible for many: “When you consider strikes have accounted for around 140,000 appointments cancelled, it’s not really a surprise that we are where we are, but I think that’s a pretty good result given where it could have been. It could be worse, it could be better, depending on circumstances... if there are more strikes before the end of March; if we have a difficult operational period.”
Trust leaders said that around 9,000-10,000 people would still be waiting more than 18 months for treatment at the end of March.
“I fear the consequence of pushing so hard on the 78 weeks will be some skewing of clinical priorities, with clinicians who might deprioritise more clinically urgent cases,” one said.
A third NHS source said their trust was doing better than expected, but that if further planned industrial action goes ahead then it would put the target “at risk”. One trust director said there were a “fair few trusts [in my region] who are a way away from getting to zero. It would be multiple thousand [nationally] ... would be my estimate,” they added.
Another leader in the South West said their backlog was into the thousands, and that this meant “constantly prioritising the long-waiters and those that need to be in more urgently”.
The NHS has seen repeated strike action by nurses and ambulance workers since December, with the most recent escalation resulting in the Royal College of Nursing (RCN) and the GMB union carrying out action on the same day. Further strike action is also likely to be carried out by junior doctors, following a ballot that is due to close this month.
NHS director Sir Jim Mackey claimed last Thursday that the NHS remained “on track to hit our next ambition by April”. However, in a statement issued on Tuesday, a spokesperson for NHS England conceded that it would miss the mark.
Instead, the statement said that the NHS remained on track to “virtually eliminate” those waiting 78 weeks for treatment by April.
“As planned, services are working hard to ensure that the number of people waiting for care continues to come down, including those who have previously chosen to wait and patients who need highly specialised treatment,” it said.
NHS England missed its previous target to eliminate the number of patients waiting for more than 104 weeks in July last year.
NHS Providers CEO Sir Julian said: “Frontline staff have eliminated two-year waits, and substantially reduced the number of people waiting over 18 months, during what has been one of the toughest periods ever for the NHS. However, trust leaders are cautious that efforts to bear down on the backlogs could be undercut by the escalating industrial action and vast workforce shortages.
“We all know that disruption from the strikes can be averted immediately by the government talking to the unions, now, about pay for this financial year. We’re also looking forward to the publication of the government’s long-term, fully funded workforce plan to ensure the NHS has the resources it needs to deliver the care patients deserve.”
Patricia Marquis, RCN director for England, said the backlog was “yet even more evidence of what happens when you fail to invest in the workforce”.
“If ministers are serious about preventing a further exodus and cutting the backlog, they need to hear the calls of NHS leaders and come to the table and talk about pay. Only then will patients receive the care they need and waiting lists start to come down,” she said.
A Department of Health and Social Care spokesperson said: “We do not recognise these figures which are clearly speculation and don’t take into account that some people will choose to wait longer for treatment.“
“We are working tirelessly to ensure the NHS has the support needed to deal with the pressures from the pandemic and winter - with waits of more than two years for NHS treatment virtually eliminated and 18 month waits cut by over 55 per cent since the peak in September 2021.
“So far we have opened 92 community diagnostic centres, which have delivered three million checks since July 2021 and will mean patients are diagnosed and treated more quickly.”
