IFS warning over recovery plan

The recovery plan sets out a number of ambitions, including NHS activity increasing by 30% over three years, over and above that already agreed. There would be a gradual reduction in waiting times, with patients waiting no longer than 18 months by April 2023, and no-one waiting longer than 12 months by March 2025. The latter target of no-one waiting more than a year has not been achieved since comparable records began in 2007, the institute said.

The IFS analysis describes three scenarios based on the NHS increasing capacity by 30% over three years, and the number of ‘missing’ patients, who did not present during the pandemic, joining the waiting list.

Hitting the 30% increase in capacity will be difficult, the IFS said. In the three years to 2019/20, activity increased by only 4.3%. And, even in the early 2000s, when real-terms NHS funding was rising at more than 6% a year, output was short of the 30% now required.

The IFS analysed scenarios where only 30% of the ‘missing’ patients present for treatment, then 50%, and 80%.

A fourth scenario would see no significant additions to the list from the missing patients, but waiting lists rising steadily, as they were pre-pandemic.

The IFS notes that the recovery plan is based on 50% of these patients turning to the NHS for treatment, and in this scenario the NHS believes waiting lists would not begin to fall until March 2024. The IFS calculates that waiting lists would peak in October 2023 at 8.7 million patients, but would not reach pre-pandemic levels until the end of 2025. There are currently 6.1 million patients on the waiting list in England.

Waiting lists would peak at 7.4 million in June 2023 in the model where 30% return for care, and fall below pre-pandemic levels in summer 2025, the IFS said. In the 80% return scenario, waiting lists would peak in December 2023 at 10.8 million, and remain several million above pre-pandemic levels by the end of 2025, it added.

However, as the IFS has argued previously, there is little evidence that missing patients have started to return in large numbers. If this continues to be the case, the institute said it was more likely that the reality will be more akin to the 30% return scenario. The backlog could well begin to be reduced before March 2024, it added.

But it said: ‘While this may be “good news” for waiting list figures, it would raise important questions about the wellbeing of the missing patients who never return for treatment. Some of those “missing” people have died and others have chosen to go private, but many more have simply not sought treatment. At this stage we simply don’t know what this will mean for their welfare or health in future, nor what it implies about the necessity of the procedures that were missed.’

In its fourth scenario, if none of the missing patients come forward but the NHS cannot find effective ways of boosting capacity, perhaps due to staffing shortfalls, waiting lists would continue to creep upwards.

NHS Confederation chief executive Matthew Taylor (pictured) said the analysis had demonstrated the enormity of the problem and that the full scale of the challenge was unknown.

He added: ‘The single biggest barrier to tackling treatment backlogs is the absence of a fully costed workforce strategy. It is impossible to see how backlogs will be cleared by March 2025 without the right number and mix of staff in place. This must be an urgent priority for government.’

While the NHS would continue to do its best, the situation is likely to get worse before it improves, he added. ‘The government must be honest with the public about this, as well as making sure it focuses on other areas of care that have major backlogs too such as in community, mental health and primary care.’