At the end of December 2021, 6.07 million patients were waiting for elective care, the biggest waiting list since records began. Only 64% (3.87 million) of these patients had been waiting for less than 18 weeks, compared with the performance standard which requires 92% to have been waiting for less than 18 weeks. Similarly, in December 2021, only 67% of patients with an urgent referral for suspected cancer were treated within 62 days compared with a requirement for 85% to be treated within that time.
The Department of Health and Social Care (the Department) and NHS England and NHS Improvement (NHSE&I) oversaw declines in waiting time performance for cancer care from 2014 and elective care from 2016 as they did not increase capacity sufficiently to meet growing demand for NHS services. On top of these previous failures and despite the heroic efforts of the NHS workforce, the COVID-19 pandemic has inevitably caused a further huge deterioration in the NHS’s provision of elective and cancer care.
A striking feature of the pandemic was that very large numbers of patients did not present at, or were unable to access, routine NHS services. As of September 2021, there were between 7.6 million and 9.1 million missing referrals of patients for elective care and between 240,000 and 740,000 missing urgent referrals for suspected cancer. People will face serious health consequences as a result of delays in treatment, with some dying earlier than they otherwise would, and many living with pain or discomfort for longer than they otherwise would.
The Department and NHSE&I are now managing a large, growing and diverse set of challenges to elective and cancer care on top of the ongoing pandemic. The Department needs to be better at communicating with NHS staff and patients about what the NHS will be able to deliver in the coming years and it urgently needs to improve its record of holding NHSE&I to account, given the additional £8 billion of revenue funding for elective recovery and £5.9 billion of capital funding. The government has told the NHS to deliver 30% more elective care activity by 2024–25 than it was delivering before the pandemic. We urge NHSE&I and the Department to be clear about what this will mean for patient waiting times and how performance may differ across the country.
Any transparent and realistic assessment of what the Department and NHSE&I expect elective and cancer care services to achieve by 2024–25 needs to include an assessment of the number of staff that will be available, how staff who have been working under intense and consistent pressure will be supported, and how patients will be kept informed about their own progress through waiting lists.