Exploring referral-to-treatment waiting trajectories in 2021

Insights on recent trends in waiting times and how waiting patterns may unfold in 2021.

7 March 2021

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This briefing explores recent trends in waiting times and considers how  waiting patterns may unfold in 2021. It accompanies Building Back Elective Care, an NHS Confederation briefing on what the NHS needs to clear backlogs of planned care as the immediate pressures of COVID-19 start to subside. 

Key points

  • 2020 saw unprecedented disruption to elective activity. This produced the largest official waiting list on record, with 4.52 million incomplete patient pathways in December 2020, up from 4.3 million a year before. Yet despite setting records, this official number is far short of where it  could be. 
  • There were 5.9 million fewer new referral-to-treatment (RTT) pathways  in 2020 compared to 2019, representing a 30 per cent fall. This number represents a hidden waiting list of people yet to join the official queue. 
  • The specialties most disrupted have been trauma and orthopaedics, and ophthalmology – areas with many conditions that will steadily worsen if left untreated. Not all patients among this hidden group  will eventually join the official list. However, it is reasonable to assume  that many will eventually find their way onto it.
  • In addition to increased numbers of people waiting, most can expect to wait far longer for care. The number of people waiting for over a year now stands at over 224,000 compared to below 1,500 a year ago, according to figures published by NHS England and NHS Improvement. But a closer look at the distribution of time spent waiting shows that 21 per cent of patients (970,000) have waited longer than half a year and 15 per cent of patients (700,293) have already waited 40 weeks or longer. 
  • By considering likely changes in future rates of admissions and outpatient  activity, we have created three models of future waiting numbers, which serve to demonstrate the scale of the challenge ahead for the NHS. 
  • The models, all of which take 2019’s activity levels as a template for normal provision, show that to maintain any sense of control over the waiting list, the NHS will need to increase capacity considerably above  levels than have previously been sustained.