The NHS waiting list in England for hospital treatment has just broken its own record, rising to 7.3 million. Just before the data dropped, the Tories issued yet another murmured apology for missing an NHS waiting time target. A promise to treat all those who had been waiting 18 months for an operation by April had not been met – with about 10,000 in that category still in line, the health secretary, Steve Barclay, admitted. Expect many more of these confessions – this one sneaked out under cover of loudly announced plans to try to improve access to GPs.
What chance of any significant cut before the next general election to the gigantic waiting list? Ask health economists and analysts, and the outlook is grim. “Vanishingly small,” says Anita Charlesworth, the director of research and economic analysis at the Health Foundation. “Close to zero,” says Nigel Edwards, head of the Nuffield Trust. “I have no doubt they will miss their targets, with more than 10% of the population waiting for treatment.”
Here are the reasons why any deep inroad into the queue looks so improbable. That 7.3 million figure hides many more who have not yet emerged into the system, as fewer people are still coming forward for treatment than pre-Covid. The Institute for Fiscal Studies says it could grow to 9 million if they all return, some sicker as a result of delaying, afraid to be a burden. That’s despite 3% vanishing from the lists each month through no longer needing treatment, going private or dying while they wait.
The government’s recovery plan aims by 2024-25 “to increase elective activity by 30%, relative to pre-pandemic levels”, which, says the IFS, looks “highly unlikely to be achieved”. The prime minister, it points out, has all but promised a meaningful fall in NHS list numbers this year, but that would require a “truly remarkable increase in how many patients it manages to treat”, or for the number joining lists to stay “unexpectedly low” because people don’t think they need care, or “because they are unable to access it”. The peak has not yet been reached. The former health secretary Sajid Javid warned that a 13 million-long list was a possibility.
Efforts to reduce the list may become like running up a down escalator. If it starts to shorten, “many more patients will come forward who are hesitating now”, says Charlesworth. Accurate predictions are impossible; much depends on next winter’s flu severity, continuing Covid, and whether threatened nurse and junior doctor strikes are settled. If nothing is done to remedy the problems in social care, hospital beds will be blocked. The uncertain inflation rate will eat away at budgets. Even good news can add to the problem: the welcome expansion of community diagnostic hubs to get people quicker scans “will find more disease that will need more treatment”, says Charlesworth.
Waiting lists are political poison: the government knows it, as did Labour. In power, it spent large sums of money cutting them to virtually nil. These days, with the NHS among top public concerns, cutting the lists is one of Sunak’s five “pledges to deliver peace of mind”. If this one looks wobbly, so do all the others: the National Institute of Economic and Social Research warns that Sunak was on track to miss his target to halve inflation this year. Immigration is rising to double pre-Brexit numbers. Despite the savagery of the illegal migration bill, his pledge to cut small boats looks equally unseaworthy. As for “We will grow the economy, creating better-paid jobs and opportunity”, even if the UK’s GDP – currently the lowest of all G7 nations – just about rises, pay will still lag behind prices for all but the top few. Nor does Sunak’s promise of “national debt falling” look likely – or if it is achieved, at what cost to things the public cares more about?
Most people are feeling the effects of the sharpest drop in incomes in living memory, but the headline NHS waiting number sticks in people’s minds. On local election doorsteps, all parties noted how virtually everyone knew someone – family, friend or colleague – waiting for treatment. That’s no surprise, with a tenth of the population on those lists.
Frantic attempts in this government’s last days can’t correct the fatal decisions it made in budget after budget that gave the lowest NHS increases ever, starting with the 2010 cuts to nurse and doctor training. “Soon” is the promise for a long-delayed NHS workforce plan, rumoured to steal Labour’s pledge to double doctor training places. Labour will up the ante. The government pumps out expensive social media ads imploring people to stay away from GPs and A&E; but if they do deter patients, people will present with worse ailments later.
Labour will stress what the Tories always avoid: underlying causes of ill-health are not within the NHS, but are in mouldy housing; polluted urban air; children arriving at school hungry; uninsulated, cold homes; and other things to be tackled in social policies Labour has already put forward. But these are long term, so Labour anxiously downplays expectations of any instant cure for an NHS so thoroughly broken by the last 13 years, knowing it will take more than one term to return it to pre-Tory standards.
Polly Toynbee is a Guardian columnist
