This briefing outlines the legal and policy background to the Mental Capacity (Amendment) Act 2019 and provides an overview of the main provisions in the new Act.
Summary of waiting times for surgery
Data is not collected specifically on waiting times for surgery, but NHS England routinely publish details of the number of patients waiting for hospital treatment in their referral to treatment (RTT) data series. The RTT data measures waiting times from referral to the start of consultant-led hospital treatment for non-urgent conditions.
Just under 4.7 million patients were waiting for hospital treatment in England as at February 2021; the highest number since the referral to treatment data series started in 2007. While a relatively sharp decrease in numbers waiting was observed from April to June 2020, numbers have since increased to their record level of around 4.7 million in February 2021. It seems likely that the dip from April to June 2020 was due to limited new referrals during the first wave of the Coronavirus pandemic.
The impact of the Coronavirus pandemic on the NHS resulted in the postponement of many non-urgent appointments and procedures, particularly during the first national lockdown. This not only increased the numbers on waiting lists, but also the time spent waiting for treatment.
In February 2020, 83% of people on waiting lists had been waiting less than 18 weeks. This proportion had fallen to 65% in February 2021.
The number of people waiting for very long periods also grew substantially in line with the pandemic period. Numbers waiting over a year for hospital treatment began to steadily increase from March 2020 onwards. By February 2021 around 388,000 patients had been waiting for over a year to be treated in a hospital.
NHS funding for recovery plans
In addition to the additional funding provided to the NHS to help manage ongoing Covid-19 pressures the November 2020 Spending Review committed £3 billion, in addition to the long-term NHS funding settlement, to support recovery.
This £3 billion allocation included £1 billion to help tackle the elective backlog and support hospitals to cut long waits for treatment by carrying up to one million extra checks, scans and additional operations or procedures.
The additional £3 billion of funding announced in the autumn Spending Review fell short of the £10 billion investment in the NHS recommended by the Health Foundation, and supported by the NHS Confederation, to deal with the impact of pressures and fall out from Covid-19 on NHS services.
On 18 March 2021 the Government announced a further £6.6 billion to support NHS England and NHS Improvement with ongoing Covid-19 costs for the first six months of the financial year 2021/22.
On 25 March 2021 NHS England and NHS Improvement published NHS Operational Planning Guidance outlined plans to accelerate the delivery of operations and other non-urgent services, and support for staff impacted by their experiences during the coronavirus pandemic. Every Integrated Care System – groups of health and other agencies working together to deliver services – is being asked to draw up a plan to ensure all hospitals maximise their capacity to do as many non-urgent operations as possible.
UK Parliament proceedings
03 Mar 2021 | 157096
Asked by: Mr Jonathan Lord
To ask the Secretary of State for Health and Social Care, what steps his Department is taking to support the provision of non-covid-19 healthcare treatment.
Answering member: Edward Argar | Department: Department of Health and Social Care (DHSC)
In addition to the £63 billion of additional funding already provided to the National Health Service in 2020-21 and a further commitment of £20.3 billion in 2021-22 to help manage ongoing COVID-19 pressures alongside non-COVID-19 activity levels, we are providing an additional £3 billion next year, on top of the long-term settlement, to support recovery from COVID-19.
The Spending Review allocated £1 billion to help tackle the elective backlog and support hospitals to cut long waits for treatment by carrying up to one million extra checks, scans and additional operations or procedures. We have also provided funding for enhanced Infection Prevention and Control measures, including £450 million to expand and upgrade accident and emergency departments to reduce overcrowding and improve infection control so we can continue to treat all patients safely.
23 Feb 2021 | 147104
Asked by: Holly Mumby-Croft
To ask the Secretary of State for Health and Social Care, what plans his Department has to set clinical priority areas for reducing the NHS elective surgical backlog as a result of the covid-19 outbreak.
Answering member: Edward Argar | Department: DHSC
Priorities for elective treatment are based firstly on clinical urgency and then by those who have been waiting longest. However, the profile of the backlog is subject to regional variation and decisions will need to take into account local needs and aim to maximise the available local capacity.
In October 2020, NHS England and NHS Improvement set out a framework and support tools to be used in the clinical validation of surgical waiting lists and support in managing the surgical backlog. These are designed to better stratify patients based on clinical urgency and facilitate mutually agreed decision making with patients.
01 Mar 2021 | 154776
Asked by: Sir Mark Hendrick
To ask the Secretary of State for Health and Social Care, what plans his Department has to reschedule cancer operations that have been cancelled during the covid-19 crisis outbreak.
Answering member: Jo Churchill | Department: DHSC
One of the key priorities outlined in the third phase of the National Health Service response to COVID-19 is to reduce the number of patients who have waited longer than 62 days from urgent referral to starting cancer treatment.
Action to reduce long waits includes expanding the capacity of COVID-19 secure cancer hubs, prioritising people for surgery centrally on the basis of clinical need and drawing on the independent sector to increase capacity.
12 Jan 2021 | 126823
Asked by: Craig Whittaker
To ask the Secretary of State for Health and Social Care, what assessment he has made of the effect on (a) patients and (b) wider society of delayed or cancelled elective procedures in hospitals in England as a result of the covid-19 outbreak; and if he will make a statement.
Answering member: Edward Argar | Department: DHSC
Latest statistics show that, since the start of the pandemic, the elective waiting list increased from 4,235,970 in March 2020 to 4,442,107 in October 2020. This compares with a waiting list of 4,446,299 in October 2019. The number of patients waiting over 52 weeks for treatment has risen from 3,097 in March 2020 to 162,888 in October 2020.
NHS England has worked with patient groups and clinicians to ensure that patients who may be subject to delayed or cancelled procedures are provided with support. A national clinical stratification programme has been established to ensure that every patient waiting for surgery by the end of December has a shared decision-making discussion about their treatment.
News and Journal Articles
The following is a selection of news and media articles relevant to this debate.
Please note: the Library is not responsible for either the views or the accuracy of external content.
BBC, 4.7 million waiting for operations in England, 15 April 2021
BBC, Covid-19: ‘Surgeries must be protected’ in any future wave, 18 March 2021
The Independent, Thousands of urgent operations building up across London as Covid pressures continue, 25 February 2021
BMJ, Growing backlog of planned surgery due to covid-19, 9 February 2021
The Guardian, Patients in limbo after cancelled cancer surgery as Covid delays NHS care, 31 January 2021
BMJ, How is the pandemic affecting non-covid services?, 22 January 2021
BBC, Covid: Urgent cancer ops cancelled in parts of London, 5 January 2021
The Times ‘Slow-motion crash’ halts routine surgery in hospitals stretched by Covid, 2 January 2021 [Subscription Required]
The Telegraph, Operations cancelled as hospitals come under pressure from Covid cases, 2 November 2020
 NHS England and NHS Improvement, NHS sets out COVID-19 recovery plan for patient care and staff wellbeing, 25 March 2021
A summary of statistics on suicide in the UK. Includes trends by gender, age, English region, and deprivation.
Summary of NHS demand, performance and capacity of services in England. Covers A&E statistics, waiting lists, ambulance data, delayed discharges, staffing levels including doctors and nurses, and more.