Six million ‘hidden’ patients could flood NHS waiting lists this year

As many as 6 million “hidden” patients could join the queue for NHS treatment in the coming months, swelling official waiting lists to records not seen for more than a decade, health chiefs have warned.

In the wake of a Budget that offered no new investment for the health service ministers must level with the public that previous guarantees on waiting times are now impossible to meet, the head of the NHS Confederation has said.

In an interview with The Independent, Danny Mortimer said some patients should expect to wait many months, or possibly even beyond a year, for their treatment.

He said: “It's going to take many years to recover the waiting list position to where we want it to be.

“We have to be realistic about the time that it will take us to address these issues, and the government have to be realistic about what it will take particularly if this week’s Budget is an indication that actually there won’t be money made available to the NHS to truly address these issues.

“The government has to take responsibility for explaining to the public what the consequences of that are.”

On Rishi Sunak’s pledge to give the NHS what it needed to cope with the effects of coronavirus Mr Mortimer said: “The chancellor has only done half the job. Tackling the elective waiting lists; tackling long Covid; the surge that we’re seeing in mental health cases; investing in public health and addressing the issues of social care is the other half of the job, and to date he’s avoided it completely.”

In a new analysis of the situation facing the health service, the NHS Confederation estimated there were approximately 5.9 million fewer patients in need of care referred for treatment in 2020 compared with 2019 – a drop of 30 per cent.

These “hidden” patients still require treatment, but do not appear on any official lists for NHS waiting times.

Based on what it called a realistic scenario of NHS activity in 2021, almost two-thirds of these patients could be expected to join waiting lists, with the total expected to grow from 4.6 million in December 2020 to more than 8 million by October this year.

Mr Mortimer said this would represent the worst levels of waiting for 10 or 15 years.

“The government have to be upfront about what this scale of waiting lists and the likely growth in the waiting lists, particularly if that hidden group of the public come forward for treatment in the coming months, will mean for people.

“It’s likely to take many years for us to get back to where we want to be in terms of addressing the number of patients on the waiting list and the length of time that they’re having to wait.”

The confederation warned in a new report that the existing system for routine surgery in the NHS is “not fit for purpose” and “piecemeal” approaches to funding and investment will fail.

It warned: “Without a comprehensive new plan, the government faces the politically unacceptable legacy of hundreds of thousands of patients left on waiting lists with deteriorating conditions for the remainder of the parliament.”

Mr Mortimer said the existing waiting time guarantees for patients would have to be suspended “for a period of time” to allow clinicians to prioritise patients by clinical need with some less urgent patients facing substantially longer waits.

“All of our members are really worried about the scale of this. They are very aware of the impact this has on patients’ lives and the lives of their families.”

The confederation says the government must invest more money to build capacity in the health service for staff to carry out operations with spending on modular operating theatres that can be quickly attached to buildings, as well as help for hospitals to create “hot and cold” sites to try and separate routine surgery from emergency care.

In November’s spending review the government earmarked an extra £1bn to help the NHS tackle long waits but the confederation said this was nowhere near enough.

Mr Mortimer warned: “There’s more the government should have done this week, to help with this. It’s not too late for them to engage with the NHS and to identify some of those investments that could make a difference in this next year.”

Hospitals have been asked to begin work on their recovery plans to be submitted this month to NHS England. Mr Mortimer warned that NHS staff needed time to “decompress after 12 months, the likes of which none of us have ever experienced in the in the health service”.

“That means the resumption of activity in the short term just needs to be carefully paced, so that we don’t make staff ill and we don’t lose people.”

Waiting lists were rising in the NHS before the pandemic with hospitals already struggling to meet demands. In 2016, the total waiting list was 3.5 million but this had risen to more than 4.3 million by the end of 2019.

In December this reached 4.6 million, the largest waiting list for 12 years. More than a fifth of patients, 970,000, have waited longer than six months while 1.5 million, almost a third, have waited longer than the 18-week treatment target.

In total, almost 225,000 patients have waited over a year for treatment by December with the number expected to increase substantially in coming months.

A Department of Health and Social Care spokesperson said: “The NHS is open for all who need it, and dedicated staff have helped millions of non-Covid patients throughout the pandemic, with 1.2 million routine appointments and operations in December alone.

“We have supported the NHS with £63 billion over the last year, plus an extra £3 billion over winter, which will help secure additional independent sector capacity, and we are providing £1 billion over the next year to help address the elective backlog.

“Average waiting times for elective treatment have fallen by 40 per cent since July and we will continue to work with the NHS to ensure all patients receive the best quality care as quickly as possible.”