The Backlog
The NHS has a waiting list of unprecedented size. What now?
Next week is a big one for me, as I kick off a three-part series for BBC Radio 4 on “the backlog” next Wednesday. The backlog is the monumental line of patients who are waiting for treatment on the NHS. I'm going to talk to staff, patients, policy experts, analysts, and politicians in the three episodes.
I want to find out how on earth we got to this point? (Hint: it isn't just covid). And I want to look at what it will take to clear the backlog.
Covid has made the backlog much worse. For two years the NHS has been battling the pandemic. Staff are exhausted and burnt out. Many of the staff I spoke to, talked about how emotionally challenging the last few years have been. One of them was the junior doctor Roopa Farooki, who wrote incredibly movingly about this difficult period of time in a new book.
The backlog has been building for years—it started long before covid. I will look at why in the programme. Official figures show around 6m waiting for hospital appointments in England. Another 1m or so are waiting in Scotland, Wales and Northern Ireland. If those numbers sound bad, then consider this: this number is completely wrong. There are millions of missing patients and millions more that are simply not being counted.
One of the main reasons for uncertainty over the numbers is that patients did not show up to see their GPs during the pandemic. They were afraid of catching covid. There are, then, millions of missing referrals for health worries that will eventually turn out to be serious issues, like heart disease or cancer. There are warnings that the waiting list could double as these patients turn up at their GPs. And, when they do, what condition will they be in?
I've been reporting on the backlog over the last month for BBC Radio 4 and for a new piece in The Economist. I've heard some harrowing stories. Of people living in agony, uncertainty, or even fear of death. Some manage their pain on a diet of opioid medications. One woman I spoke to takes up to eight Tramadol a day. The pain is still unbearable at times. (People develop a tolerance to opioids over time, and can develop abnormal pain sensitivity.)
They talk about the anxiety of waiting, of being left “in the dark” of not knowing when their surgery will happen and when their life will resume. Can you imagine what it feels like to get to a surgery date after years of waiting, and then have it cancelled while you are in the theatre, waiting? Some are slowly deteriorating, losing their eyesight (which they cannot get back), or mobility. Some are deteriorating past the point that the NHS can treat them.
As for deaths, well data from the British Heart Foundation shows that 6,000 more people than expected have died from heart and circulatory conditions during the pandemic1. The heart charity thinks that disruption to treatment will have contributed to this number. The same sort of thing has been seen in the US—with an uptick in deaths that may be linked to delays in heart surgeries. And the National Audit Office thinks that there are more than 240,000 missing urgent referrals for suspected cancer since the start of the pandemic.
Names, not numbers
One patient, Mary, wrote to me to tell me her story. She was a former sister and bed manager at St Thomas's hospital in London. She is facing a two- to four-year wait for knee replacement. She has now downsized to a bungalow in the “boonies” to help with her mobility. She describes herself as an ardent supporter of the NHS, but even she feels she may now be facing a private bill for knee replacement. That is quite a brutal turn of events for someone whose knees gave so much to the NHS on our behalf.
In the first episode of The Backlog, which broadcasts at 4pm on Wednesday 9th of February I'll find out what we know about the scope of the backlog, and how it got this bad. I'll also talk about whether money is going to fix the problem. (Hint: no, they need more staff and that is hard to do). Episode 2, broadcast a week later, will just talk about staff. It is such an important issue. And Episode 3: will look at solutions.
And if we are really lucky, at some point in the next three weeks the government might even let us have a look at its plan to deal with the backlog.
Lastly, I would like to thank the many people who have taken the time to speak to me. I’d particularly like to thank those who were not officially interviewed for broadcast, but took the time to fill my brain with useful insights. These include Andy Cowper, of the column Cowper’s Cut at Health Policy Insight; Rob Findlay an expert on waiting lists at Insource, Alastair McLellan the editor of the Health Service Journal, and Axel Heitmuller, the managing director of Imperial College Health Partners. And thanks also to the brilliant producers who have pulled it all together. Maggie Latham, Craig Smith, Paul Connolly & Julie Bell.
Programme details
The Backlog, BBC Radio 4.
The NHS faces a monumental backlog of patients waiting treatment. So how exactly do we tackle the backlog? The Economist’s Health Policy Editor, Natasha Loder looks for answers.
Ep1: Demand: Wednesday the 9th of Feb, 4pm,
Ep2: Workforce: Wednesday the 16th of Feb, 4pm,
Ep3: Solutions: Wednesday the 23rd of Feb, 4pm,
Editor: Maggie Latham. Series Producer: Craig Smith. Producers: Paul Connolly & Julie Ball.
Between March 2020 to January 2021