Backlogs in the NHS

This debate pack covers what backlogs the NHS is facing, government activity to address backlogs and stakeholder commentary. Health policy is devolved, this information applies to England.

UPDATE: Since the publication of this debate pack, on 6 January 2025 the government announced the publication of an Elective Reform Plan to end waiting list backlogs. This is not reflected in the PDF download which is dated 2 January 2025.

What backlogs is the NHS facing?

Health services are under pressure and face significant capacity issues. An ageing population with increasingly complex care needs, high demand and inflation are all contributing to a reduction in timely access to services. Sources of pressure in the NHS include declining productivity, issues around capital investment, high rates of bed occupation and delayed hospital discharges. The Library has published an article on factors that could be contributing to capacity pressures in the NHS.

Before 2020, the NHS in England experienced increasing demand and declining performance on its main waiting time measures. Many of these pressures have increased following the covid-19 pandemic.

Key NHS waiting times standards are not being met. For example:

• In England, the 18-week treatment target has not been met since 2016 and waiting lists for hospital treatment rose to a record of 7.7 million people in September 2023.
• The percentage of patients waiting over 4 hours in hospital A&E rose consistently between 2015 and 2020. A new record high was reached in December 2022.
• The 62-day waiting time standard for cancer treatment has not been met in recent years.

For full details of key NHS statistics in England, including on A&E waiting times, hospital waiting lists, ambulance response times, staffing levels and more, see the Commons Library briefing on NHS key statistics: England.

Government policy on NHS backlogs

Government health mission and Autumn Budget 2024

The government has said it intends to end hospital backlogs this parliament by meeting the target that 92% of patients should not wait longer than 18 weeks from referral to starting consultant-led treatment of non-urgent conditions.

In the 2024 Autumn Budget, the government announced funding to support 2 million extra NHS operations, scans and appointments a year in England to help reduce waiting times for elective care. It has said that its next steps to end backlogs will be to:

• transform how elective care is delivered
• transform patients’ experience of care
• transform the model of care to make it more sustainable

10-year health plan

The government said it will publish a 10-year health plan in spring 2025 to “reform” healthcare by shifting from “hospital to community” care, rolling out new technologies and focusing on preventing illnesses by identifying and managing issues earlier.

Darzi Report

In July 2024, Wes Streeting, Secretary of State for Health and Social Care, commissioned Lord Darzi to carry out an independent investigation into the NHS in England. The final report of the investigation (‘the Darzi report’) was published in September 2024.

Lord Darzi ultimately concluded that the NHS is in “serious trouble” (page 1), and he noted issues around poor access and quality of care. He said various factors had contributed to the current state of the NHS, including low capital investments, the covid-19 pandemic, patient and staff disengagement and the “constant reorganisation” of NHS structures and systems.

The Library debate pack on Lord Darzi’s Independent Investigation into NHS performance discusses in more detail the findings of the report, recommendations it made and how it was received.

The Darzi report noted various issues around NHS backlogs. It highlighted issues with poor and varied access to GPs, growing waiting lists and long waiting times. In particular, the report noted the backlog in adult ADHD assessments and said at current rates it “would take an average of 8 years to clear” and for many trusts “the backlog would not be cleared for decades” (page 34).

Lord Darzi acknowledged the impact of the pandemic on increasing the NHS backlog. However, he also said countries with greater pre-existing capacity and that more effectively contained the covid-19 pandemic were “in a better position to cope with care backlogs … and recover from its consequences” (page 107).

Lord Darzi emphasised that resources must be shifted into community health services and social care to reduce the strain on hospitals. He argued that whilst this has been a central tenet of health policy for some time, it has been undermined by financial flows and “knee-jerk” responses from ministers that focus spending on hospitals. He said this funding distribution is reinforced by performance standards that focus on hospitals.

Lord Darzi also noted disparities in access to and outcomes of care for some ethnicities, highlighting longer waits for elective care for Asian people.

Stakeholder Commentary

A report published in October 2024 by the Nuffield Trust highlighted how headline figures on NHS backlogs can hide demographic disparities in access to NHS care. The report analysed how NHS waiting times can vary by age, sex, ethnicity and level of deprivation and found:

• Waiting list sizes and times for planned NHS care, and how they have changed over time, vary by what people are waiting for. For example, trauma and orthopaedic services, and ear, nose and throat services, had the largest waiting times in May 2024 and made up nearly a fifth of the total waiting list size. Respiratory medicine services saw the largest increase in total waiting list size in the past decade (263%), and gynaecology services had the second largest (223%).
• Older people are more likely to be waiting for planned NHS care, but younger people are more likely to say they have longer waits for planned care.
• People from the most deprived areas are more likely to be waiting for care.
• Experience of waiting varies between ethnic groups.

Commenting on the government’s plan in the October 2024 budget to reduce the backlog through funding to support two million extra yearly appointments and diagnostics, the King’s Fund said the investment was “much needed and to be welcomed, particularly to unlock productivity gains”. However, it also said that “without further commitments” the NHS may struggle to meet rising demand for care. It pointed to rising NHS buildings and equipment costs to be addressed that it said stands at £13.8 billion and a need for enough NHS staff to help bring down waiting lists.

In June 2024, The Health Foundation said that there “are no quick fixes” to solving the backlog in the NHS. It recommended the government “to make better use of existing hospital capacity and invest in expanding capacity for the longer term”.

In February 2024, the Institute of Fiscal Studies said that reducing waiting lists for elective treatment in England to pre-pandemic levels was going to be “highly unlikely within the next parliament”. It highlighted a need for dedicated additional funding to the health service and increased NHS productivity.