Intended for healthcare professionals


Large push to meet NHS operations backlog falls short on hitting targets

BMJ 2023; 381 doi: (Published 11 May 2023) Cite this as: BMJ 2023;381:p1083
  1. Adrian O’Dowd
  1. London

Intense efforts to try to reduce elective and cancer care backlogs in part created by the covid-19 pandemic have fallen short of promised national targets, figures for England have confirmed.

The NHS target to eliminate 78 week waiting lists for elective care by April this year was missed, although the number waiting that long has been reduced by 91% over the past 18 months from 124 911 patients in September 2021 to just 10 737 by April this year, NHS performance data showed.1

Overall waiting list numbers have risen to more than 7.3 million in England, up from 7.22 million in February, and a record high.

The target to reduce the number of people waiting more than 62 days to start cancer treatment to around 14 200 (as was seen before the pandemic) by April of this year was also missed as there were 19 248 people waiting that long by the end of March. The numbers, however, are down from a peak of 34 000 people in July of last year.

But there has been some progress, such as ambulance response times for life threatening incidents falling by more than an hour to their fastest level in nearly two years, and 2.3 million diagnostic tests performed in March—the highest monthly number ever.

On the 78 week elective care waiting times, NHS England said that despite winter pressures, around half (49.6%) of NHS providers had no one waiting other than those who had chosen to wait longer or who needed complex surgery.

NHS England chief executive, Amanda Pritchard, said, “The great strides the NHS is making on long waits, urgent and emergency care, and cancer services in the face of incredible pressure is testimony to the hard work, drive, and innovation of colleagues.

“There is still much to be done but these are remarkable achievements given all the NHS has had to contend with—including flu and covid driving record demand that made for the busiest winter in our history.”

Still no workforce plan

Doctors’ representatives said the figures underlined the need for a workforce plan.

Vice president of the Royal College of Surgeons of England, Tim Mitchell, said, “Record staff vacancies, high levels of covid-19 and flu over the winter, and industrial action have all hampered recovery efforts.

“NHS staff are doing the best they can to cut waiting lists but until there is a clear workforce plan in place to deal with the chronic staff vacancies that impede the day-to-day running of the NHS, the situation remains difficult.”

NHS organisation representative bodies praised staff efforts but acknowledged more needed to be done.

Rory Deighton, director of the NHS Confederation’s acute network, said, “Thanks to the phenomenal efforts of its staff, the NHS has considerably slashed the 78 week elective care waiting list. While the list has not been completely cleared and the overall waiting list has risen, the NHS has done everything it can to recover its services following the pandemic and will continue to do so.”

Julian Hartley, chief executive of NHS Providers, said, “Trusts have pulled out all the stops to cut by 90% the number of people waiting 78 weeks or more for care—a remarkable achievement against a backdrop of months of strikes, severe staff shortages, and a yawning gap between capacity and demand.

“Staff and trust leaders deserve credit for continuing to work to see people as quickly as possible and to improve the flow of patients through the whole health system. But there’s a long way to go to get waiting times and lists down.”