The delivery plan for tackling the covid-19 backlog of elective care falls short
Jessamy Bagenal
Abstract
Treating the more than six million people currently on the elective waiting list in the UK is a gargantuan task. There are no easy solutions, and the list is likely to get longer before it gets shorter. 1 But the backlog is also a direct result of a poor national response to covid-19, coupled with an NHS that was under resourced, underfunded, and understaffed even before the pandemic. 2 The NHS lacked the right balance of hardware (infrastructure, finance, workforce) and software (management knowledge, skills, trust) or any necessary excess capacity to respond to the shock of the pandemic. 3 A plan to tackle the backlog needed to start from this foundational point. Sadly, NHS England and Improvement's recent plan: Delivery plan for tackling the covid-19 backlog of elective care, does not. 4 By any measure, the extent of the backlog is a serious failure. Patients are suffering physically and emotionally, which contributes to poorer health. Confidence and trust in the system are weakened, and the economic consequences are huge for individuals and society. How we respond to the backlog is therefore crucial. Getting it right will provide a "resilience dividend" of improved future care in both good times and bad times. The plan acknowledges the scale of the problem, recognises it as an opportunity to transform care, and-importantly-recognises the unequal distribution of waiting times: waiting lists in the most deprived areas have grown by 55% whereas those in the least deprived areas have grown by 36%. 6 But the plan fails to acknowledge the legacy of policies introduced over the past decade. It promises to increase elective activity by 30% by 2024-25, but does not acknowledge that before the pandemic, the waiting list grew from 2.9 million pathways in January 2015 to 4.4 million pathways in December 2019. 7 It would, of course, be politically difficult to make such an admission, but avoiding this means the ambitions of the plan start from the wrong place.