Between 240,000 and 740,000 potential cancer cases have been missed as people stayed away from GPs during lockdown.

A new report out this morning from the National Audit Office also found that up to 60,000 fewer people started treatment for cancer than would have been expected.

Since the start of the COVID-19 pandemic, the NHS has had to redirect much of its resources to treat COVID-19 patients and to implement infection, prevention and control measures. In January 2021, an average of 24,100 general and acute care beds were being used by COVID-19 patients (31% of all those occupied). Between January and September 2021, an average of 35% of unoccupied general and acute care beds had to be set aside for COVID-19 patients.

COVID-19 disruption was inevitably going to cause a sharp increase in waiting times and backlogs in a healthcare system that had been operating at very close to its maximum capacity.

By September 2021, there were 5.83 million patients on the waiting list for elective care, of whom 1.95 million patients had been waiting for more than 18 weeks, including 301,000 waiting for more than a year.

By June 2021, NHS cancer services activity had recovered to pre-pandemic levels. However, since the start of the pandemic (up to September 2021), patients with an urgent GP referral for cancer were more likely to be delayed – 26% had to wait more than 62 days for treatment to start.

It is also uncertain , said the report, how many of the “missing” cases will return to the NHS to seek treatment and over what time

It is also uncertain how many of the “missing” cases will return to the NHS to seek treatment and over what time period, though clearly many will. The NHS will need to increase its activity to meet this surge in demand. Even if it can adapt, the scale of the challenge it faces is daunting. If 50% of “missing” referrals for elective care return to the NHS and its activity grows only in line with pre-pandemic plans, the elective care waiting list will reach 12 million by March 2025. If 50% of “missing” referrals return and the NHS can increase activity by 10% more than was planned, the waiting list in March 2025 will still be 7 million

Ruth Thorlby, Assistant Director of Policy at the Health Foundation, said:  

‘The NAO’s report has delivered a cold dose of reality about the scale of the challenge facing the NHS in the years ahead. Even before the new Covid variant emerged, the NAO warns that the record-breaking waiting lists could grow even bigger before they improve. Any more disruption risks making the mountain to climb that much higher. 

‘Given the huge uncertainty, the government’s NHS recovery plan needs to be realistic about the complexity of bringing waiting lists down and how long it may take to do so. This means striking a balance between meeting increased demand for care, supporting the wellbeing of patients waiting longer for treatment and an under resourced and overstretched workforce exhausted from the pandemic.  

‘It also needs to be a practical strategy that supports innovation and improvement, while not being top down, punitive or target driven. The NAO report rightly highlights that the recovery challenge is not the same everywhere with some areas hit much harder than others. Any solutions, therefore, such as relocating patients for treatment, should aim to actively address these unjustified disparities and, at the very least, must avoid exacerbating the existing inequalities that have been widened by the pandemic.  

‘Recovery is more than just about hospitals. Any plan must include ways to boost services in primary care and in the community, to help prevent people from becoming acutely ill and relieve pressure on hospitals. Social care especially needs urgent funding, both to enable people to leave hospital promptly and keep people well at home.’


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