Engage: What issues need to be tackled to address the NHS waiting list backlog?

The Government has pledged to tackle the elective care backlog with the “biggest catch-up programme” in the history of the NHS.

A record 5.6 million people were waiting to start hospital treatments such as hip and knee replacements and cataract surgery at the end of July, according to the most recent figures from NHS England.

But experts have warned the NHS waiting list could reach 13 million. The Government has said it will spend £2 billion this year and more than £8 billion in the following three years to deliver the equivalent of around nine million more checks, scans and procedures.

Here the PA news agency looks at some of the issues that need to be tackled if the backlog is going to be addressed.

Recruiting and retaining staff

Richard Murray, chief executive of the King’s Fund think tank, said that the backlog had been growing long before the coronavirus pandemic, with too few staff and beds to meet an increasing demand for care.

In a submission to the Health Select Committee, the King’s Fund said that the “key rate-limiting factor” stopping the treatment of more patients was the availability of staff.

In addition, an analysis by the Health Foundation said that to tackle the backlog the NHS workforce would need to grow by up to 277,500 full-time equivalent staff by 2024-25.

But training home-grown doctors and nurses takes a long time and Mr Murray believes retaining existing staff already exhausted from the pandemic and recruiting from overseas will be vital in the short-term.

He said: “They are going to have to increase capacity where they can but increase productivity at the same time.

“Some of that will be trying to retain nurses and bring new doctors from abroad but it’s also how many people can that capacity treat, raising productivity, making better use of those operating theatres.”

Sarah Scobie, deputy director of research at the Nuffield Trust, agrees that providing more support and flexibility to staff could stop them leaving the NHS.

“There’s lots of thing already being looked at, so supporting more flexible working so people won’t drop out because they don’t have enough choice and flexibility about when to work,” she said.

“Anything we can do to increase the participation of existing staff that are already trained is going to be a lot quicker and cheaper than training people from scratch.”

Having enough beds and equipment

The King’s Fund argues that longer-term investments in things like operating theatres and large-scale diagnostic equipment will also be needed.

It told the Health Select Committee that there was a “significant up-front cost and lengthy procurement process” for equipment such as such as CT and MRI scanners.

The Department of Health and Social Care (DHSC) has said local surgical hubs, which are being piloted across the country to help “fast-track” the number of planned operations, will be expanded to tackle the backlog.

Ms Scobie said that areas could “pool” their waiting lists so that people on one hospital’s list for a particular surgery could be treated at another.

But she said that a key question was how to expand these schemes to different parts of the country where people might not be close to multiple hospitals or clinics.

Ms Scobie also warned that high numbers of Covid-19 patients in intensive care unit (ICU) beds mean there is not the always space needed for people undergoing complex operations.

She added: “Complex operations can’t be undertaken unless there’s an ICU bed available, just in case a patient needs it.

“But patients in ICU with Covid are often in there for a lot longer than someone post-operation. So one Covid patient could be holding up several complex operations.”

Funding uncertainty and boosting capital spending

It is not yet clear how all the new cash from the health and social care levy will be distributed across the NHS in England.

This means that finance directors at hospital trusts still do not know exactly how much their organisation will receive and therefore cannot yet make key decisions on bringing in more staff or investing in more equipment.

Mr Murray said that there were also questions about NHS capital funding – money for buildings, infrastructure and equipment such as new operating theatres and diagnostic equipment such as CT and MRI scanners.

The Health Foundation’s REAL Centre estimates that the capital budget will need to rise from £6.4 billion in 2018-19 to £10.3 billion in 2024-25 to enable investment in equipment and bed capacity.

But Mr Murray told PA that the money raised by the health and social care levy was revenue funding for day-to-day costs such as salaries and administration costs.

This means that more capital funding will need to be found to fulfil Government promises to buy more diagnostic equipment, open new operating theatres and rebuild hospitals, he added.

Mr Murray told PA that he was expecting capital numbers to be in next month’s spending review.

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