NHS waiting list may not be cleared until 2030 without ‘deeper and faster' reforms, Tony Blair Institute warn

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The NHS waiting list backlog caused by the pandemic may not be cleared until the end of this decade unless the government carries out “deeper and faster” reforms than it has already set out, a major paper by the Tony Blair Institute says.

Boris Johnson last month unveiled plans to increase capacity in the health service to 130 per cent of pre-pandemic levels to reduce the millions waiting for treatment delayed due to covid.

But modelling by the former Prime Minister’s organisation shows this cannot be achieved by 2025 at the earliest, or as many as five years later if coronavirus continues to put pressure on the NHS, without radical reform.

It says the looming crisis coming this winter will not be a one-off because of the combination of covid, the waiting list backlog and staff shortages.

The paper, which has the support of former health secretaries Jeremy Hunt and Alan Milburn, puts forward what it says is a “credible plan to help the NHS to recover from Covid-19 and put it on a sustainable footing will be key to the next general election”.

The proposed reforms include an emergency plan to use private sector beds for NHS patients to start to clear the backlog in the short-term, and prioritise more urgent waiting list cases over routine surgeries.

In the long-term, the authors suggest deeper reforms including decentralisation of services like diagnostics, with more patients carrying out tests for illnesses at home, which could be more publicly acceptable due to the increasing use of self-administered covid lateral flow tests.

A proportion of the 40 new hospitals the Prime Minister has pledged by 2030 should be “smart hospitals”, which use more artificial intelligence and digitisation of records.

Medicine should shift to become more preventative and personalised, with individuals able to access their own genomic sequencing giving them greater autonomy over their own health, and use wearable technology to monitor things like blood pressure.

Scans and other diagnosis tools could be outsourced to countries with lower pressures on their health systems, such as New Zealand or Australia.

Modelling by the institute suggests that peak flu admissions during January 2022 could plausibly exceed 10 per cent of general hospital beds and 15 to 20 per cent of intensive care beds in a worst-case scenario. 

“Even without a major Covid-19 winter surge, therefore, the NHS could easily be reduced to 70 per cent capacity or less, based on expected Covid and flu trends,” the authors say.

In May 2021 there were more than five million people waiting for routine operations and procedures in England, but ministers have warned that the backlog could grow to 13 million.

If additional capacity was increased to 110 per cent of 2019 levels next year and by 130 per cent by 2024, waiting lists would be reduced to pre-pandemic levels by the end of 2024, the paper says.

By Daniel Sleat, head of research at the Tony Blair Institute for Global Change

The NHS is in the midst of a deep and multi-faceted crisis. It faces the two interconnected challenges of the impact of Covid-19, as well as the underlying structural problems of perennial underfunding, short staffing, and an increasingly ageing population. 

The Government has set out plans to support the service through what is being described as a potential “winter crisis”. These plans fall short of what is required. The NHS faces a crisis not just of one season, but to its long-term future.

Modelling by the Tony Blair Institute (TBI) shows that without further and faster action by Government the backlog of cases exacerbated by Covid will be with us for many years. 

We believe the solution to this lies in partnering with the private sector to access extra capacity to work through the backlog. From conversations with independent sector providers we understand such a partnership is not only feasible but would allow the NHS to work through waiting lists far faster than currently forecast. 

Extra steps also need to be taken to lift the burden on the service, including embracing the short-term opportunities that technology can offer through online services, decentralised diagnostics, artificial intelligence and robotics.

Significant numbers of people are going private for care. Even more may end up doing so if the NHS isn’t able to deliver for the public. The immediate backlog of cases and underlying systemic challenges put this capability at risk. It is time for bold action to save our health system.

But a bad covid and flu season this winter could push this recovery back to 2025. Continued pressure from covid during the next two years could delay the recovery even further to the end of 2025, and if the burden of covid remains more permanent, as an annual threat in addition to flu, then the waiting list would not return to pre-pandemic levels until the late 2020s.

Daniel Sleat, one of the report authors, said: “The NHS is in the midst of a deep and multi-faceted crisis. It faces the two interconnected challenges of the impact of Covid-19, as well as the underlying structural problems of perennial underfunding, staffing, chronic illnesses and an ageing population. 

“The Government has set out plans to support the service through what is being described as a potential ‘winter crisis’. These plans fall short of what is required. The NHS faces a crisis not of one season, but to its long-term future.”

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