Background:

The Covid-19 pandemic has had a large impact on healthcare systems, leading to many patients with non-Covid-19 conditions having their care postponed or delayed. We aimed to forecast the impact of the pandemic on waiting lists for treatment in the National Health Service (NHS) in England.

Methods:

Using monthly data published by NHS Digital on all patients referred for elective treatment (including surgery) in England, we estimated the number of fewer referrals to treatment during the pandemic compared to the year prior to the pandemic (“the hidden need”) i.e. patients who would have sought care if the pandemic had not occurred. We modelled the impact on NHS waiting list numbers and times up to 2025, taking account of the observed increases in waiting lists and the impact of this hidden need as patients begin to seek treatment for unmet health needs.

Results:

Assuming no additional capacity is made available in the NHS, the number of patients waiting for treatment was estimated to increase from ~4.2 million in 2019 to 8.7 million by 2024, a 102% increase from pre pandemic levels. Taking account of the hidden need resulted in an additional doubling of the size of the waiting list to a peak of 15.4 million and bringing forward the peak to 2023. We estimated significant geographical and therapy area disparities and identified regions (e.g. North West England, London) in England that we expect to be disproportionately impacted by the waiting list increases.

Conclusions:

Healthcare systems and payers like the NHS in England face a major challenge in tackling a backlog of care resulting from disruption to the treatment of patients for conditions other than Covid-19. This also includes meeting the unmet health needs of patients who did not seek care during the pandemic and whose conditions remain untreated.