With the potential to reach 10 million patients by March 2022, England’s National Health Service (NHS) total elective waiting list has become an urgent priority. Driven by decreased elective activity during the Covid-19 pandemic, waiting list growth from 4.4 million in February 2020 to 5.0 million in March 2021 was worryingly accompanied by a 30% decline in new referrals to treatment (RTTs). Our forecasts show that the return of even just half of these “missing” RTTs will drive overwhelming waiting list growth over the next year and beyond.
Simply returning to pre–Covid-19 activity levels will not be sufficient to achieve the transformation needed to meet this demand—neither will requiring more work from already exhausted NHS staff or additional funding alone. Rather, the crisis ahead can accelerate innovation and be the catalyst for reimagining elective care pathways at the front line, applying this at scale within systems, then rolling out great solutions across the nation.
The authors wish to thank Freddie Quiney, orthopaedic trainee and Bain senior associate consultant, for his support and for the benefit of his clinical experience, and Mythili Sutharson for her analytic modelling support.