Daily Junction.mobi portalNews · October 15, 2024 · Daily Junction Editorial Team · 9 min
NHS England data shows waiting lists have reached a record 7.8 million patient pathways, with over 400,000 people waiting more than a year for treatment. Staff shortages, industrial action, and post-pandemic backlogs continue to strain the health service as winter approaches.
The NHS waiting list crisis has reached unprecedented levels, with 7.8 million patient pathways recorded in September 2024 according to NHS England's latest Referral to Treatment (RTT) data. Over 400,000 people have been waiting more than a year for treatment, and emergency department performance has fallen to its lowest level outside of the pandemic, with only 65% of patients seen within the four-hour target. The crisis is driven by a toxic combination of post-pandemic backlogs, chronic staff shortages, industrial action, and rising demand from an ageing population. As winter approaches—traditionally the most challenging period for the NHS—health leaders warn the service is at breaking point, with patient safety at risk and staff morale at an all-time low.
The headline figure of 7.8 million waiting represents individual patient pathways, not unique patients—some people are waiting for multiple treatments. However, even accounting for this, NHS England estimates around 6.2 million individuals are on waiting lists, approximately 11% of the English population.
The breakdown reveals the depth of the problem:
The specialties with the longest waits are orthopaedics (joint replacements, spinal surgery), ear, nose and throat (ENT), ophthalmology (cataracts, glaucoma), and dermatology. These are often conditions that significantly impact quality of life but are not immediately life-threatening, making them vulnerable to repeated delays.
While elective waiting lists dominate headlines, emergency care performance has deteriorated sharply. In September 2024:
The Royal College of Emergency Medicine estimates that 14,000 excess deaths in 2023 were associated with long A&E waits, based on analysis of mortality data and wait times. While causation is difficult to prove definitively, the correlation between deteriorating emergency performance and excess mortality is stark.
Staff shortages are the single biggest constraint on NHS capacity. As of September 2024, NHS England reported:
The vacancy rate of 8.2% means that for every 12 staff the NHS needs, one post is unfilled. This creates a vicious cycle: existing staff work longer hours to cover gaps, leading to burnout and higher attrition, which worsens shortages.
Industrial action has compounded the crisis. Junior doctors and consultants took strike action on 32 days between March 2023 and September 2024, the longest period of industrial action in NHS history. While disputes have now been resolved with pay settlements, the strikes led to an estimated 1.2 million cancelled appointments and procedures, adding to the backlog.
Retention is as critical as recruitment. NHS staff survey data from 2024 shows:
The COVID-19 pandemic suspended routine elective care for months in 2020 and 2021, creating a backlog that has proven far harder to clear than anticipated. During the first wave (March-June 2020), routine surgery was almost entirely suspended, with only cancer and urgent cases proceeding.
While the NHS resumed elective care in summer 2020, subsequent waves and infection control measures (requiring longer gaps between procedures, reduced theatre capacity) meant activity remained below pre-pandemic levels throughout 2020-2022.
NHS England's Elective Recovery Plan, published in February 2022, aimed to eliminate waits over 18 months by April 2023 and return to the 18-week standard by March 2025. Progress has been slower than planned:
The Nuffield Trust, an independent health think tank, estimates the NHS will not return to the 18-week standard until 2026-2027 at the earliest, and only if funding increases and workforce grows as planned.
Even without the pandemic, the NHS would face rising demand. The UK population is ageing rapidly:
Multimorbidity—having two or more long-term conditions—affects 27% of adults and is strongly age-related. Managing multimorbidity requires more GP appointments, specialist input, and hospital admissions.
Obesity rates have risen from 26% in 2010 to 29% in 2024, driving increases in type 2 diabetes, cardiovascular disease, and joint problems requiring surgery. Mental health demand has surged, particularly among young people, with referrals to Child and Adolescent Mental Health Services (CAMHS) up 60% since 2019.
The NHS budget has grown in real terms, but not fast enough to keep pace with demand. NHS England's budget for 2024-25 is £165 billion, a real-terms increase of 3.6% on 2023-24. However:
The Health Foundation, another independent think tank, projects the NHS will face a £14 billion funding gap by 2030 if current trends continue. This assumes demand grows at 4% per year and productivity returns to pre-pandemic levels—if productivity does not recover, the gap could reach £20 billion.
The Labour government, elected in July 2024, has made NHS recovery a priority. In the Autumn Statement 2024, Chancellor Rachel Reeves announced:
Health Secretary Wes Streeting has been blunt about the scale of the challenge, stating in October 2024: "The NHS is broken. Waiting lists are at record highs, staff are burnt out, and patients are suffering. We will fix it, but it will take time—this is a 10-year project, not a quick fix."
The government has also commissioned Lord Darzi, a surgeon and former health minister, to conduct an independent investigation into NHS performance. His interim report, published in September 2024, concluded that the NHS is in "critical condition" due to underinvestment in capital (buildings, equipment) and workforce over the past decade.
For individuals on waiting lists, options are limited but include:
1. Patient Choice: Under NHS rules, you can choose to be treated at any qualified provider, including private hospitals contracted to the NHS. Ask your GP or consultant if alternative providers have shorter waits.
2. Clinical prioritisation: If your condition worsens, contact your consultant's secretary to request re-assessment. Urgent cases are prioritised.
3. Community alternatives: For diagnostics (scans, tests), ask if community diagnostic centres have shorter waits than hospital-based services.
4. Private treatment: If financially viable, paying for private treatment can bypass NHS waits. However, this raises equity concerns and does not solve the systemic problem.
5. Complaints and advocacy: If you experience unreasonable delays or poor communication, raise concerns with the hospital's Patient Advice and Liaison Service (PALS) or the Parliamentary and Health Service Ombudsman.
The UK is not alone in facing healthcare pressures, but NHS performance has deteriorated more sharply than comparable countries. OECD data from 2023 shows:
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