Background

During the pandemic, elective surgery was suspended to allow hospital resources (including anaesthetists) to be diverted towards managing COVID-19 patients. This led to a significant increase in the already substantial number of patients on waiting lists.

In response to this, the government published the ‘COVID Recovery Plan’ in February 2022, with the headline aim of increasing elective activity to 130% of pre-pandemic levels by 2024/25.

Ambitions

As well as its headline aim, the recovery plan includes four main ‘ambitions’:

1. No patient should wait more than 12 months for elective care by March 2025 (this should involve all waits over 24 months being eliminated by July 2022, 18 months by April 2023, and 65 weeks by March 2024).

2. By March 2025, 95% of patients requiring a diagnostic test should receive it within 6 weeks.

3. Cancer: 75% of GP referrals for cancer should be diagnosed or ruled out within 28 days by March 2024; the number of people waiting more than 62 days for urgent treatment after referral should be back to pre-pandemic levels by March 2023.

4. For patients awaiting an outpatient appointment, to use technology and work with patient groups and stakeholders, to improve both waiting times and patients’ experience of waiting, over the next three years (to February 2025).

Areas of Focus

The plan focuses on four key ‘areas of delivery’:

• Increasing health service capacity including physical separation of elective and emergency services.

• Prioritising diagnosis and treatment including the six week target for diagnostic tests and other ambitions above.

• Transforming the way we provide elective care including increased flexibility of GP appointments and greater use of surgical hubs.

• Providing better information and support to patients e.g. better use of the NHS app and increased choice at the point of referral.

It also acknowledges the importance of maintaining low levels of COVID-19 to enable the NHS to ‘restore normalised operating conditions and reduce high levels of staff absence.’

Progress So Far

The aims of the Delivery Plan are ambitious and there has been a mixed picture of progress so far.

Increase elective activity to 130% of pre-pandemic levels

NHS England also set an interim target of reaching 110% of pre-pandemic levels in 2022/23. However for most of 2022, elective activity was lower than the corresponding level in 2019. November 2022 was the first month where elective activity rose above pre-pandemic levels, reaching 104.8% of the level in November 2019, but on current trends it seems unlikely that the 130% target will be met.

Reduction in waiting times

There has been a strong focus on the longest waiting times, with the number of patients waiting more than two years reduced to only 277 in July 2023. The number of patients waiting more than 18 months also fell from 124,911 in September 2021 to 11,477 in April 2023 and 7,289 in July 2023. This means that although progress was made on the ambitions of eliminating waits greater than two years by July 2022 and 18 months by April 2023, these were not achieved.

However, as the level of elective activity has not significantly increased, these reductions have been at the expense of shorter waiting times. The number of patients waiting over 12 months has increased from 300,000 in February 2022 to 390,000 in July 2023 (in February 2020 it was 1,845).

In July 2023 the median wait time was 14.1 weeks, up from 13.1 weeks in February 2022, and nearly double the pre-pandemic median wait of 7.3 weeks in July 2019.

Cancer wait times

The target of 75% of GP referrals for cancer to be diagnosed or ruled out was set in April 2021; that month, 73% was achieved. This declined to 67% in January 2023, but has since improved to 74.1% in July 2023, and it seems likely that this can be achieved by the ambition of March 2024.

In March 2020, 78.8% of patients received their first cancer treatment within two months of GP referral. This fell to 63.5% in March 2023 and was at 62.6% in July 2023, so the ambition of returning to pre-pandemic levels by March 2023 was not achieved.

Industrial Action

It has been suggested that industrial action by doctors since March 2023 is the cause of the ambitions of the elective recovery plan not being met. However, on most of these ambitions, progress had been limited before the start of industrial action, and independent analyses generally predicted that they would not be met.

References

NHS England: Delivery plan for tackling the COVID-19 backlog of elective care

NHS England: Consultant-led Referral to Treatment Waiting Times Data 2023-24

NHS England: Cancer Waiting Times

Institute for Government: Performance Tracker 2022/23: Spring update - Hospitals (Feb 2023)

BMA: NHS Backlog Data Analysis (updated regularly)

IFS: One year on from the backlog recovery plan: what next for NHS waiting lists? (Feb 2023)

The Health Foundation: Managing expectations: the NHS’s challenging activity and efficiency targets (Dec 2022)

National Audit Office: Managing NHS backlogs and waiting times in England (Nov 2022)

NHS Confederation: Analysis: The state of the elective recovery in numbers (Oct 2022)