Addressing the backlog: an election promise with a long-term prognosis

With just under 4 weeks to go until the UK heads to the polls, debate over key election topics is hotting up.

Unsurprisingly high on the election campaign agenda is the NHS, specifically how to solve the current capacity challenges ailing the service. Whilst capacity issues are present across the service from GP appointments to social care, the challenge is perhaps most starkly shown by NHS elective waiting lists. As of most recent NHS data from March 2024 these stand at 7.5 million incomplete pathways, still over 3 million higher than the start of the pandemic and a two-and-a-half-fold increase over the last 10 years.  

Efforts have been made by the current Government to tackle the backlog, with some progress made, especially on long waiters, but lists across the country remain stubbornly high. In response Labour has pledged the most ambitious plans to date, promising to eliminate 18-week waits within 2 years through a combination of additional appointments and equipment.

As LCP Health Analytics has previously highlighted, it’s important to delve into the backlog data and understand what it is really showing us. This is not only key for the electorate as they make their decision about our future Government on 4 July, but for all those that will continue to work on tackling this challenge across healthcare and life sciences now and going forward.

Why does addressing the backlog remain a key policy priority?

Public debate on waiting lists numbers has been ongoing since the pandemic. Over the course of the years, it’s easy to become desensitised to what the numbers actually represent. Ultimately every figure of that 7.5 million is someone waiting for a procedure they need, far longer than they should. This impacts their quality of life now, their ability to work but also could have long term repercussions for their health. These numbers also represent significant pressure felt by NHS staff every day, with ongoing industrial action and the recently published results from the 2023 NHS Staff Survey underlining this. Finally they represent an economic cost to our country, with previous work between IPPR and LCP revealing that addressing the backlog could result in economic benefits worth at least £73 billion over the course of 5 years.   

So where do we currently stand in the waiting list queue?

The picture has changed very little since last year. Nationally, elective waiting lists have come down slightly over the last couple of months, from a peak of 7.8 million last year to now 7.5 million as of March 2024. Waits longer than 18 weeks stand at 3.2 million and waits longer than 52 weeks are 309k. Total waits are only half the picture, and we see regional disparities ongoing, with the North-West and East of England still having the highest population adjusted waiting lists.

Increase in RTT waiting lists, after adjusting for population size, across the UK since March 2020

Source: LCP Analysis, Consultant-led Referral to Treatment Waiting Times Data 2023 - 24

What is becoming apparent is that some areas of the country are evidently doing better on implementing measures to improve capacity, with the South West in particular seeing the smallest relative increase between March 2023 and March 2024.

From a specialty standpoint, the same specialties as 2023 still have significantly worse waits than others. Orthopaedics remains the specialty with the largest number of waits (835k), followed by ENT (639k), Ophthalmology (611k) and Gynaecology (591k). 

Improving capacity: No mean feat

The largely unmoving picture reminds us that tackling this challenge is no easy task. Indeed improving the elective backlog has long been a government priority, with the elective recovery plan (ERP) published in February 2022 setting out targets to eliminate long waits following the pandemic. Despite this, progress has been slow. Our analysis shows that elective activity over 2023-24 was, on average 1.45 million completed pathways monthly, which is an increase of 5.4% vs 2022-23 and 0.6% vs pre-Covid 2019-201. For context, the ERP targeted a 30% increase in elective activity vs pre-Covid by May 2025, of which, the NAO documented a planned increase in completed pathways of 15.5% vs pre-Covid over 2023-24. Essentially this means we are a significant way off meeting the aspirations of the ERP even with one year to go.   

These figures highlight the scale of the challenge for the next government of whatever colour when it comes to tackling the waitlist, and specifically when it comes to the feasibility of targeted policies around eliminating 18 week waits in the next two years. There is nothing wrong with the ambition to do this, but it has to be grounded in the reality of what is achievable and in the systemic changes that are happening in our society that is influencing health outcomes.  

No silver bullet: the long-term fix

By its very nature, our political system is based on short-termism and a four-year time horizon. What is clear with the enduring challenges of waiting lists is that there will be no silver bullet or quick fix, particularly after the unprecedented strain of the pandemic. Improving capacity will certainly be a key enabler and, as we have made the case for previously, data should be used appropriately to identify where targeted intervention will be most beneficial. Partners to the healthcare system, like the life sciences, also have a role to play here by bringing innovation that can alleviate capacity, including technology like virtual wards and new medication that does not require hospital intervention.  

It’s clear that a longer-term solution is needed to fix our NHS’s endemic demand versus supply competition. This should be a priority for any new Government and this challenge is set to rise; more than 50% of adults are now living with a complex, chronic health condition which requires a different model of treating to our acute-based system. This model should be based off the principles of population health, where we see our NHS and the wider ecosystem as an exporter of health rather than an importer of illness. Data and technology will also be key to understanding health risk factors and inform clinicians to intervene only when needed.

This isn’t a quick fix solution, and one where all partners across the healthcare ecosystem will need to collaborate together long after the forming of a new Government this summer to enable.