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Seven million people in England are currently waiting for treatment on the NHS.
That’s more than the entire populations of some countries, including Denmark and New Zealand.
For many, the delays will be adding to their existing anxieties over having a serious — even life-threatening — illness.
Just under half of those referred to a specialist will have been in the queue for longer than 18 weeks — the maximum target set in 2004 by the Government. And more than 360,000 of them will have been waiting a year or more.
It’s a deeply troubling state of affairs that has been thrown into sharp focus by the impact of the junior doctors’ strike.
While the impact of the virus may have worsened the bottlenecks, the problem of rising patient demand is of longer standing (file image)
Last week’s four-day walkout by medics demanding a 35 per cent pay rise was expected to lead to the cancellation of another quarter of a million appointments (striking doctors on April 14)
Last week’s four-day walkout by medics demanding a 35 per cent pay rise was expected to lead to the cancellation of another quarter of a million appointments and operations across the NHS.
However, ‘treatment delays existed long before the doctors’ strike — and also the Covid-19 pandemic,’ Danielle Jefferies, a senior analyst with independent think-tank The King’s Fund, told Good Health.
Indeed, while the impact of the virus may have worsened the bottlenecks, the problem of rising patient demand is of longer standing. And the potential consequences are terrifying.
Studies show that for each month patients with breast, bowel or head and neck cancers have their treatment delayed, the chances of them dying from the disease increase by 6 to 13 per cent.
Meanwhile, eye specialists fear some people may suffer permanent sight loss because they cannot get to a specialist in time to prevent the worsening of serious conditions such as glaucoma, which affects around 700,000 people in Britain.
‘This is extremely urgent,’ says Mel Hingorani, a consultant ophthalmologist at Moorfields Eye Hospital in London and honorary secretary of the Royal College of Ophthalmologists. ‘We are seeing people develop sight loss as a result of being unable to access services.’
Waiting lists for common complaints
Cancer patients waiting: 229,721
Heart conditions patients waiting: 372,803
Joint patients waiting: 792,000
Eye care patients waiting: 656,000
Gynaecology patients waiting: 570,000
What’s more, according to figures obtained under the Freedom of Information Act, an estimated 117,000 people in England died in 2021 while awaiting NHS treatment.
But what are the driving forces behind this crisis? Good Health looked at some of the worst-hit sectors to unravel the truth.
According to NHS England targets, 93 per cent of patients in England given an urgent cancer referral should be seen by a specialist within 14 days. Latest NHS figures show that in February, only 86.1 per cent were seen within that target time.
Cancer Research UK says this means at least 16,000 patients a month missed out on being seen within the targeted time (based on the 93 per cent target).
Similarly, only 58 per cent of cancer patients were started on treatment (such as chemotherapy or radiotherapy) within 62 days of an urgent referral. The target in England is 85 per cent, which means that nearly 4,000 patients began treatment later than they should have done, Cancer Research UK claims.
The charity’s director of evidence and implementation, Naser Turabi, told Good Health: ‘There isn’t a single bit of the system that does not have shortages.
‘The first step for most patients is seeing the GP — there are problems accessing them and if they do, GPs often don’t have enough time — but it can take a long conversation to arrive at a suspected cancer case.’
Other countries with better cancer outcomes, such as Norway, Australia and Germany, spend up to 40 per cent more on cancer care and have much higher levels of referrals (i.e. a lower threshold for suspicion of cancer and more investment in diagnostics) than the UK, he says.
And this has knock-on effects: a recent report by the NHS Confederation found UK survival rates lag behind the European average in nine out of ten cancer types.
Despite improvements in UK cancer outcomes, patients here still face a lower chance of survival from stomach, bowel, lung, breast, ovarian and prostate cancers than patients in Germany, France or Italy, for instance.
Naser Turabi says that for the UK to improve, large-scale investment is needed to bolster hospitals’ diagnostic services.
‘There aren’t enough GPs to assess patients and put them on the cancer pathway [i.e. the process by which they get diagnosed and treated],’ he says. ‘And even if there were, we’d need a lot more scanners and staff.’
In February this year, around 1.23 million people were waiting for key cancer diagnostic tests in England. Of these, 22 per cent have been waiting six weeks or more.
One improvement that Cancer Research UK is pushing for is training for radiographers — who carry out X-rays and MRI or CT scans — to identify cancers and raise the alarm over any suspicious images.
Currently, they must pass the images on to radiologists — medically trained doctors — to assess them, even though there is a shortage of radiologists, meaning that scans are not always checked promptly.
‘It’s a real missed opportunity,’ says Naser Turabi. ‘Radiographers could be easily trained to prioritise the scans that need urgent treatment.’
More patients in England are waiting for cardiac care — ranging from a heart scan to the insertion of a pacemaker or reopening of a blocked artery — than at any time in history; a record 372,803 in February this year, according to NHS data. This is a 60 per cent jump on February 2020 figures.
Worse still, more than 136,000 had spent more than the NHS target of 18 weeks in the queue for potentially life-saving heart care and almost 10,000 had been waiting over a year for often time-critical heart tests and treatments.
The British Heart Foundation says high demand is partly due to a rise in patients seeking help for problems that were not attended to during the pandemic, as well as the growing needs of Britain’s ageing population.
In Scotland, figures (available up to June 2022) show the number of heart patients waiting more than four months jumped to 5,083 — nine times pre-pandemic levels.
In Wales, up to August 2022, 37 per cent of people waited eight weeks or more, compared with just 6 per cent of people in August 2019. And in Northern Ireland, at the end of September 2022 there were 3,271 waiting; up 43 per cent on pre-pandemic levels.
‘Each month, we are seeing far too many people waiting far too long for time-critical heart care — waiting too many weeks for a heart test that could unlock life-saving treatment or even a year for heart surgery,’ says Dr Sonya Babu-Narayan, associate medical director at the British Heart Foundation (BHF).
According to a report published by the charity in December 2022, this is due to ‘too few staff being trained to keep up with demand’.
So how long will you wait?
The NHS Constitution says that patients should be seen within 18 weeks once referred to a specialist.
But this has proved an impossible target, as these NHS England figures, from February 2023, reveal. Proportion of patients seen within 18 weeks of referral:
- Elderly medicine: 81.7 per cent
- Heart/lung surgery: 66.7 per cent
- Respiratory care: 65.5 per cent
- Internal medicine: 65.3 per cent
- Rheumatology: 64.8 per cent
- Neurology: 56.3 per cent
- General surgery: 55.4 per cent
- Orthopaedic: 54.2 per cent
- Gynaecology: 54.1 per cent
- Plastic surgery: 53.1 per cent
- Oral surgery: 52 per cent
- Ear, nose and throat: 51.4 per cent
One particular area of concern is a shortage of cardiac physiologists — experts who carry out tests such as echocardiography, where ultrasound is used to check on the state of the heart. This is vital for assessing damage to cardiac muscle from a heart attack, monitoring heart failure (where the heart struggles to pump blood around the body) and diagnosing birth defects that stop hearts working properly. Without these checks, the chance to prevent someone’s condition deteriorating may be missed.
The BHF report found almost 80 per cent of NHS cardiac units struggled to recruit qualified staff for tasks such as echocardiograms. It warned: ‘We won’t tackle long waiting lists for heart tests if these shortages are not addressed.’
The BHF has called for the Government to set up surgical ‘hubs’ across the country to tackle the backlog of heart surgery, plus more community diagnostic centres where patients can get faster diagnoses rather than face hospital delays.
It says ministers have committed to some of its proposals in the elective recovery plan — a blueprint drawn up in 2022 to tackle the surplus of patients needing treatment as a result of delays caused by the pandemic.
One of the NHS sectors worst hit by the pandemic-induced restrictions on surgery was hip and knee replacement surgery, which effectively ground to a halt when hospitals filled up with Covid patients.
Across England, 792,000 patients are waiting for treatment for everything from broken bones to hip or knee replacements. And nearly half of them — 363,000 — have been on the list for more than 18 weeks, according to NHS data for February 2023. More than 52,000 have been on the waiting list for at least a year and 353 for two years or more.
In Scotland, up to December 2022, just under 47,000 patients were waiting to be seen for orthopaedic problems — nearly 1,500 of them for more than a year; while in Wales 98,555 were awaiting treatment at the end of January.
In Northern Ireland, almost two-thirds of the 25,000 or so people needing treatment have to wait at least a year.
Need a scan? Join the queue
PATIENTS WAITING: 1.58million
Scans and other investigations are vital for diagnosing serious illnesses. But data reveals that 1.58 million people in England alone were waiting for an appointments at the end of January — up almost 9 per cent from the same time in 2022. These include:
- Ultrasound: 535,949
- MRI scans: 294,469
- CT scans: 182,610
- Echocardiography (for heart ailments): 164,825
- Audiology (hearing) checks: 81,964
- Colonoscopy (to check on the bowels): 79,926
- Gastroscopy (for stomach problems): 66,985
- Dexa scan (for bones): 62,469
- Flexible sigmoidoscopy (to check the bladder): 27,553
- Peripheral neurophysiology (for diabetes): 26,088
Deborah Alsina, chief executive of the charity Versus Arthritis, says: ‘Joint replacement waiting times are destroying the lives of people with arthritis who desperately need surgery and support.
‘Some are having to give up work, struggling to walk down the stairs or even leave their homes.’
The charity is calling for a network of ‘surgical hubs’ — hospitals with facilities ring-fenced for planned joint surgery — so that more operations can be done.
Of all the medical specialties across the NHS, ophthalmology has one of the largest treatment backlogs — more than 656,000 in England alone at the last count (up to November 2022), which is more than the entire population of the city of Bristol.
But the Royal College of Ophthalmologists claims the numbers needing help could be much higher because they only include patients awaiting a first appointment, usually to get a diagnosis.
The numbers don’t include the thousands more waiting for delayed follow-up appointments to manage their chronic conditions, such as glaucoma, which is a leading cause of blindness.
Around 700,000 people in the UK are affected by glaucoma, where the optic nerve (which connects the eye to the brain) becomes damaged by a build-up of fluid, and they can need three or six-monthly checks to make sure their treatment (usually drops to reduce pressure in the eye) is working and their vision is not deteriorating.
The College warns that permanent vision loss is nine times more likely to occur in follow-up patients than in new ones.
Mel Hingorani, the honorary secretary of the Royal College of Ophthalmologists, says: ‘We aim to see all high-risk patients (those in most danger of permanent vision loss) every three to four months and low-risk patients every 12 to 18 months.
‘But 75 per cent of NHS trusts cannot attract the number of consultant ophthalmologists they need to cover the workload — and we are starting to see people with sight loss as a result.’
As well as 40 per cent more consultants to cope with the expanding workload, there have been calls for the NHS to make better use of Britain’s 14,000 optometrists — who work alongside High-Street opticians but are specialists in screening for eye disease — in order to meet some of the shortfalls in hospital care.
Around 570,000 women in England are living with extreme pain, heavy bleeding and declining mental health because they cannot get to see an NHS gynaecologist — in some cases waiting for years, according to the Royal College of Obstetricians and Gynaecologists.
Covid restrictions were especially bad for this specialty as many operations considered non-urgent were cancelled.
Many awaiting surgery for conditions such as fibroids (benign growths in the womb) or incontinence fell into this category.
In a 2022 report, the College warned that the number of women in England waiting more than a year for treatment soared from less than one in 1,000 before the pandemic to more than one in 20 afterwards.
It surveyed 837 women stuck on waiting lists for conditions such as endometriosis — which affects one woman in ten of reproductive age and causes heavy and excruciatingly painful periods — and found that 80 per cent had suffered a decline in mental health as a result of the delays. Three-quarters of the women said it was affecting their work and social life.
The College wants the NHS to focus funding on areas where the waiting lists are longest, and also to ring-fence cash in order to tackle the backlog.
Faye Farthing, head of communications and campaigns at the charity Endometriosis UK, told Good Health: ‘Gynaecology is one of the worst-affected areas when it comes to NHS waiting times and it’s having a huge impact on women’s lives.
‘We even hear of women losing their jobs because they are not able to work due to pain.’
At risk of going blind
Charlotte Cheetham, 62, a former occupational health nurse, runs a cattery with husband Peter, 64, and lives in Somerset. They have three grown-up children. She says:
Charlotte Cheetham, 62: I don’t know how quickly my vision might deteriorate to the point where I am blind. It’s a frightening prospect
Back in November last year, I was told I needed ‘urgent’ surgery to save my sight — and I’m still waiting to have it.
I have open-angle glaucoma, which means that fluid that should keep the eye healthy instead builds up and is pressing on the optic nerve.
The optic nerve sends vision messages to the brain so damage to it could leave me blind.
The condition was picked up by an eye test about ten years ago. Initially, I was prescribed eye drops (which reduce the production of fluid), but gradually my vision got worse.
It has quite a big knock-on effect on my life. I can no longer drive; I can just about read and watch television with glasses, but my distance vision is badly affected.
At my check-up in November, I was told the pressure around the optic nerve in my right eye was so bad that I needed an urgent operation to insert a shunt (a hollow tube) to keep the drainage channels open.
But it still hasn’t been done. The appointments have been cancelled five times in all — once, last month, owing to the junior doctors’ strike.
I now have a date for today and I am dreading getting a call to say that it, too, has been cancelled.
I’m pretty depressed about the delays. I don’t know how quickly my vision might deteriorate to the point where I am blind. It’s a frightening prospect.
We can’t start a family
Josie Sensier, 29, works in mental health and lives in Manchester. She says:
Josie Sensier, 29: I work for the NHS and I know we’re all struggling. But waiting times are unreasonable. I feel I’m in limbo and it’s devastating
I’ve been waiting over 12 months to see a gynaecologist; I fear it might take years. I have endometriosis — a painful condition in which tissue similar to the lining of the uterus grows elsewhere, making it, among other things, difficult to get pregnant.
The repeated cancellations and long wait are having a terrible impact on me and my partner. It’s so frustrating.
Not only are my dreams of motherhood on hold, but my symptoms can be agonising: pain, sickness and heavy bleeding can leave me bedbound for days.
There’s a procedure known as a laparoscopy, where they look inside the abdomen and remove any extra endometriosis tissue.
That would reduce my symptoms and increase my chances of having a baby. I’ve had it before — in 2012 and 2016 — but I need it again as the tissue can regrow.
The problem is I cannot get in front of a specialist even to arrange the procedure.
And I know from experience that once I see a gynaecologist it can then take another nine months to have it done on the NHS.
My GP referred me in March 2022, and my first appointment finally came through in February this year. But it’s since been cancelled five times owing to clinics being ‘reorganised’.
I work for the NHS and I know we’re all struggling. But waiting times are unreasonable. I feel I’m in limbo and it’s devastating.
Too much pain to walk
Caryl Wright, 72, volunteers in a cathedral shop and lives in Norwich. She says:
Caryl Wright, 72: I worry that if the surgery on my left knee isn’t done soon I won’t even be able to care for myself at home
I first developed pain in my right knee ten years ago and a scan showed that it was osteoarthritis — wear and tear of the joint.
The doctor said I may need surgery at some point but to manage with painkillers. By 2017 it was absolute agony.
I couldn’t straighten it properly or walk on anything except flat ground. I was put on a waiting list for surgery and had to wait two and-a-half years to have my partial knee replacement in June 2022.
But any relief was short-lived because, almost immediately afterwards, I felt pain in my left knee. I couldn’t believe it.
I had waited so long to be pain-free. I saw my consultant in July, who said that during the long wait for surgery in my right knee, I had been limping and putting extra pressure on the left side, so the arthritis there had got worse in that time.
I now needed a full joint replacement in my left knee, and was warned — again — that the waiting list was long. That was months ago and I’ve still had no news.
I live outside Norwich in the countryside and loved going for walks, but now it’s too painful.
I had to give up my hobby of singing because I can no longer stand for long periods, and also had to give up as a cathedral tour guide because I cannot walk for long.
I worry that if the surgery on my left knee isn’t done soon I won’t even be able to care for myself at home.
Case study interviews: Angela Epstein, Julie Cook and Lucy Elkins