Rush to clear NHS backlog could leave poorest behind, warns new analysis

A rush to cut NHS waiting lists for surgeries such as hip replacements could inadvertently worsen health inequalities with richer patients being treated sooner, according to a new analysis.

The study by the Health Foundation think tank has identified a large gap between the most and least deprived parts of London, in terms of the number of admissions for hip surgery during 2020, as the NHS recovered from the first wave of Covid.

While the most deprived parts of London saw a 30 per cent fall in admissions for hip replacements during 2020, the least deprived areas of the city saw only a 15 per cent fall.

The disparity is also regional too, with London managing to get back to its pre-Covid levels of activity for hip surgery while other parts of the country fell behind. The Health Foundation found the Midlands and the northeast and Yorkshire regions were worst affected with 50 per cent fewer admissions. This meant 15,000 more patients in the Midlands and 11,000 more in the northeast and Yorkshire waiting for surgery.

The Health Foundation said if all England’s regions had recovered to the same extent as London, there would have been 19,000 more hip operations by the end of 2020.

One of the reasons London recovered faster is thought to be its younger population, its lower infection rates throughout the autumn and its use of specialised hubs for some surgeries away from busy hospital sites affected by Covid. This approach is being rolled out across England.

But Charles Tallack, assistant director of the Health Foundation, told The Independent the analysis served as a warning to the NHS bosses that they needed to consider how their plans to recover the NHS backlog would impact on poorer communities so that they were not disadvantaged as had happpened in London.

He said: “There will be waiting lists for some time to come. Clearly there will be desire to reduce waiting lists and get waiting times back to more usual levels. There is a risk here that if we don’t get this right it could exacerbate existing inequalities.”

According to the study, 58,000 more people were waiting an extra 25 weeks for a hip replacement in England by January this year, compared with levels before the pandemic.

The impact this had with people being left in pain and unable to live a normal life is the equivalent of losing 29,000 years of life spent in good health, the authors said.

The NHS in England carries out 330 elective hip replacements a day but this fell to an average of between one and two a day during March and April 2020 with the NHS still not yet back pre-pandemic levels following the January wave and lockdown.

The overall NHS waiting list as grown to 5.5 million people – it’s largest since records began.

Around four million fewer people were treated in 2020 compared to 2019, with six million more people not even referred by GPs and who have yet to join the waiting list. This is why some have warned waiting lists could balloon to 13 million.

The Health Foundation team also looked at the diagnosis of diabetes, which affects nearly 5 million people in the UK and warned delays in diagnosis and treatment could have severe impacts on patients and the NHS.

Across England there were 26 per cent fewer new cases of type 2 diabetes diagnosed in 2020 compared to 2019. This is equivalent to 40,000 missed cases.

Referrals to diabetes management schemes to help people live with the condition were also down 35 per cent. The report warned for some patients the delays could lead to serious consequences.

The report said: “The health impacts of the pandemic go beyond Covid-19. We cannot simply count the cost in terms of Covid-19 deaths, nor can we expect that as the pandemic wanes, the health impacts will wane too. Instead, the almost total suspension of routine NHS care, and the consequent backlog, will have consequences that stretch well into the future.

“When we look at hip replacements, London has returned more quickly to pre-pandemic levels of care than other regions. But in doing so, those from the wealthiest areas seem to have benefitted the most.

“Prioritising patients and maximising efficiency in a way that does not exacerbate inequalities is not straightforward – and is a challenge that will be repeated across NHS care. Using efficient hubs could maximise the number of patients seen and reduce average waiting times, but is this worth it if it comes at the cost of increasing inequality? Should patients be prioritised based on how long they have been waiting and clinical need? Or should wider factors be considered, such as the impact on their quality of life or personal finances?

“Frontline clinicians and managers will be facing these questions, again and again, for months to come. How they decide to balance the moral, financial, and political elements of fairness – and how this is approached across the country – will be one of the biggest ever challenges to the NHS’s promise to deliver high-quality care, that is fair and timely for all.”