The COVID-19 pandemic disrupted healthcare services in most of the world. In the United Kingdom, these disruptions resulted in millions of patients waiting weeks or even months to receive secondary care. While some manage to find alternatives, waiting may be deadly for others.
On November 9, 2022, a Healthnews reader who lives in England and did not want to be identified to avoid undesirable consequences asked their GP for a referral to an ophthalmologist.
Almost three weeks later, they received a letter informing them that the appointment at the Royal Bournemouth Hospital was arranged for June 14, 2023. In the same letter, the patient learned that their appointment had been canceled.
The hospital says that the appointments may be canceled for various reasons, including staff sickness or absence, operational pressures reducing the volume of planned activity they are able to undertake, and “rescheduling to ensure patients who need to be soon earlier, or who have waited the longest, are seen in a timely way.”
Those who had their appointments canceled should contact the hospital or their GP, according to the hospital’s statement sent to Healthnews.
The patient now plans to receive care in their country of origin. And this is not an isolated case, as approximately 63,000 UK residents travel abroad for medical treatment every year.
Recent media stories describe patients who were told to wait for surgeries, such as hip replacement, for several years and chose to undergo treatments paid from their own pocket in other countries. The others, however, have no choice but to wait.
Over 7 million people in the backlog
The National Health Service (NHS) includes the publicly funded healthcare systems of the UK. Most services provided by the NHS organizations are free, and patients are only required to pay for prescriptions, dental and eye care. People with low incomes can also receive these services free of charge.
Before the COVID-19 pandemic, the British had a positive attitude toward their health service. According to the 2019 survey, 53% were very or quite satisfied with the way the NHS was run. In 2021, satisfaction dropped to a record low of 36%.
The shift in opinion during the pandemic may be related to the rapidly growing NHS backlog in secondary care during this period, as the analysis by the British Medical Association (BMA) shows.
The backlog is defined as the care that would have normally been delivered if the pandemic had not disrupted the services. It includes patients who have not yet presented to their GP to seek a referral for their symptoms, those waiting for treatment, or those who had their procedures or referrals canceled.
The BMA estimates that at the beginning of the pandemic, the total waiting was 4.24 million patients. On September 22, 2022, the number reached 7,07 million. While the average waiting time for the treatment was 13.9 weeks, about 2.91 million patients have been waiting over 18 weeks.
The waiting time for care is increasing, too. According to the BMA, 401,537 patients are waiting over a year for treatment. Before the pandemic, only 1,305 people waited for more than 12 months.
“It will take years to clear the backlog. The ongoing need for stringent infection prevention control measures and workforce shortages mean it will take even longer to work through as demand continues to rise,” the BMA concludes.
Cancer patients cannot wait
And while the Healthnews reader did not need urgent care, for some, waiting may cost lives.
In September 2022, about one in four (27.4%) people with suspected cancer had to wait more than two weeks to be seen, equating to almost 70,000 people — a new record high.
In the same month, 5,700 people in England with confirmed cancer diagnoses had been waiting to start the treatment for more than two months after their urgent referral.
“Despite the very best efforts of NHS staff, delays to diagnosis and treatment can be incredibly traumatic for people living with cancer, causing huge amounts of anxiety and potentially impacting their chances of survival,” said Steven McIntosh, Executive Director of Advocacy and Communications at Macmillan Cancer Support.
The Brits have to wait not only for secondary and cancer care. BBC analysis reveals that by late November, around 11,000 ambulances were waiting more than an hour at the hospital emergency department (A&E) every week. A patient handover is expected to take 15 minutes.
Ambulance response times are also on the rise, with the average response to a Category 2 call at over 1 hour in October 2022, nearly seven times more than the 18 minutes target.
Clearing the backlog may not be easy
In February, NHS England laid out the plan to tackle the backlog. The plan foresees that waits of longer than a year will be eliminated by March 2025
Among the means to do so is the new recruitment and technology allowing to reduce the administrative burden on staff, offering patients the treatment option by independent sector providers for free, and new community diagnostic centers allowing them to take more tests at the same time.
The government pledged to spend more than £8 billion ($9.62 billion) until 2025, supported by £5.9 billion ($7.1 billion) investment in capital, such as new beds and equipment.
Nevertheless, implementing the strategy may not be very easy. A recent report from the National Audit Office highlights that the NHS’s funding package is being eroded by inflation; therefore, the overall funding up to 2024-25 is set to grow more slowly than the long-term average in real terms.
“Given progress to date, we are concerned that the 129% activity target and the target to eliminate all waits of longer than 52 weeks by 2025 are at serious risk of not being achieved,” the report says.
Privatization of the NHS
The privatization of the NHS has been a topic of discussion for several years. In 2012, the Health and Social Care Act was adopted, allowing patients to choose services from independent sector providers that meet NHS costs.
But it did not necessarily improve the quality of care. The study published in the Lancet Public Health found that consistently increasing privatization of the NHS in England through the outsourcing of services to for-profit companies correlated with significantly increased rates of treatable mortality between 2013 to 2020.
Treatable mortality is defined as the causes of death that can be avoided through timely and effective healthcare interventions.
The study authors suggest the rates have increased as the result of “a decline in the quality of healthcare services.”