NHS acute capacity

Page last updated: 21 October 2022

In last year’s State of Care, we highlighted the reduction in healthcare activity at the beginning of the pandemic, citing a fall of 69% in the number of new referrals to treatment between February and April 2020.

As at July 2021, there were a total of 5.6 million people waiting for treatment (incomplete referral to treatment pathways). Five per cent of these had been waiting for more than a year. The Institute for Fiscal Studies, in its most optimistic scenario has projected that the number of people on NHS waiting lists will jump to nine million in 2022, returning to pre-pandemic levels by 2025. In its worst case scenario, it would jump to 14 million in 2022.

The management of waiting lists and prioritisation will be key as we move into recovery. For those experiencing delayed care, there is a need to provide interim support.

Many acute services have addressed the challenge of care provision during the pandemic by increasing the use of digital technology and telephone appointments to meet demand. For example, between April and September 2020, the proportion of face-to-face child and adolescent mental health (CAMHS) appointments fell from 74% to 30% of all appointments when compared with 2019 (545,000 fewer appointments). Whereas the proportion of CAMHS telemedicine webcam appointments increased from less than 1% to 9% of all appointments (276,125 additional), and CAMHS telephone appointments increased from 22% to 54% of all appointments compared with 2019 (636,135 additional).

After the initial prioritisation of urgent care, there was a gradual push to bring systems back in line with pre-pandemic levels and in meeting the NHS Long Term Plan goals. Of the four NHS acute areas we analysed (cancer, cardiovascular, A&E, and mental health) in the year following the start of the pandemic (February 2020 to March 2021), cancer services have achieved the best response and recovery, generally closing the gap in access on pre-pandemic levels more so than any others, though this still leaves a large backlog.

Even before the pandemic, cancer services were struggling to meet demand. At the beginning, additional stresses from lockdown measures and redeployment of resources towards COVID-19 care caused widespread disruption to the cancer care pathway. In the first month of the pandemic, between March and April 2020, the number of people seen by a specialist following an urgent referral dropped from 183,603 to 80,031 (57% reduction) (figure 2).

Between April and September 2020, this number recovered from 80,031 to 201,013. Despite this recovery, between March and September 2020 there was a total of 335,555 fewer people seen by a specialist following an urgent referral from a GP in 2020 compared with 2019.

In autumn and winter 2020, cancer service capacity was once again affected, although the impact appeared to be far less apparent than at the beginning of the pandemic, possibly indicating learning and better preparedness. There were still 19,553 fewer patients seen following an urgent referral between November 2020 and February 2021 than between November 2019 to February 2020. However, it is encouraging to see that the number of people seen since February 2021 is now above the 2019 average.

The impact on cancer referrals appearing to be smaller in the autumn and winter 2020 compared with the start of the pandemic is also reflected in cancer treatment. However, this is not seen so clearly in other acute services, such as cardiovascular services.

In the first month, between March and April 2020, the total number of new pathways, following referral-to-treatment, for cardiology fell from 56,471 to 24,597 (figure 3) and echocardiographic waiting lists increased by more than 11,000 (a 30% increase).

Although new pathways showed some signs of recovery from April 2020, capacity is yet to consistently match pre-pandemic levels. This contributed to a growing backlog of people waiting to, or not starting, treatment; in total there were 194,180 fewer new pathways initiated in cardiology between April and September 2020, compared with the same period in 2019 (a 41% reduction).

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