We are now 18 months into the COVID-19 pandemic and its impact on the health service is likely to reverberate for many years to come. A huge 5.6 million people are already waiting for treatment, but strange as it may seem, this waiting list needs to grow much further.
What the current waiting list figure does not show is the likely colossal unmet and pent-up need of those yet to come forward for treatment, those whose needs are still, for a whole plethora of reasons, unknown to their local health services – these are the estimated 7 million people who could make up the ‘hidden’ waiting list.
The pandemic will leave in its wake a backlog of care in excess of anything we have seen over the last decade
The scale and complexity of the challenge now faced by the NHS, and the sheer size of what it must deliver, is unprecedented, and we know the pandemic will leave in its wake a backlog of care in excess of anything we have seen over the last decade.
The Prime Minister has already acknowledged that the waiting list is likely to grow substantially before things get better and the health and social care secretary has warned that it could top 13 million.
However, while making inroads into the list and ensuring patients are being seen as quickly and efficiently as possible for their treatment, the health service will also crucially need to turn its attention to finding those who have not come forward for treatment and are not yet known to the system.
It is a fact that waiting lists have grown more rapidly during the pandemic in areas of higher deprivation. We also know many of these patients will be from deprived and marginalised groups and that these inherent and enduring health inequalities will only get worse unless we deliver what one NHS chief executive has described as a ‘generational change’ in our approach to healthcare.
We know that our members across the health service have worked harder than ever over the course of this pandemic, providing both COVID-19 and non-COVID-19 care.
Primary care teams have also done an incredible job in delivering a vaccination programme, which through determination, collaboration and creativity, has ensured that people in traditionally harder-to-reach communities have had contact with vaccination teams and been offered the opportunity to have the jab.
The health service now needs to find the same drive and commitment to find the missing 7 million patients who require access to vital health care. Systems will need to balance that aim of growing the waiting list, while at the same time being mindful of the increased demands this will place on an already very busy and tired workforce, not an easy task.
New and imaginative approaches
However, to truly live up to the health service’s founding principles of care being free at the point of use, on the basis of need and not ability to pay, NHS leaders know that they must find a radically new approach to dealing with the waiting list backlog.
Getting this right will require the NHS to reach out to local communities in new and imaginative ways. Many local NHS providers, primary care services and integrated care systems are already doing this, going out into their local communities, including to places of worship and social clubs, an approach that has reaped enormous dividends for the uptake of the vaccination programme.
A positive pandemic legacy must be that we set in stone those founding NHS principles once again
NHS leaders at University Hospitals Coventry and Warwickshire for example are working with primary care teams to proactively seek out people who may need treatment but have not come forward by using information from the local strategic needs assessment to discover areas where referrals are lower than would be expected compared to the needs of the population.
A positive pandemic legacy must be that we set in stone those founding NHS principles once again and make sure all those who need care get that care on the basis of that need. Doing this will lead to a fairer society and is something we must tackle head on if we are to turn the tide on those deprived and marginalised groups experiencing worse outcomes for their care.
Matthew Taylor is chief executive of the NHS Confederation. Follow him and the organisation on Twitter @FRSAMatthew @nhsconfed
This article was first published in The Times.