The pandemic has had an enormous impact on the NHS, from bed shortages to exhausted staff. It has been known for some time that operations were being delayed or postponed as covid took centre stage, but this is the first time the figures have been tallied up – and the result is shocking.

A total of 1,568,664 operations fewer than expected took place in England and Wales in 2020, and this is predicted to reach 2.4m by the end of this year. These figures come from a study in the British Journal of Anaesthesia and are the first to actually quantify the number of operations that did not take place as a direct result of the pandemic.

Did we succeed in protecting the NHS?

The number of people waiting for surgery in England has now surpassed 5million for the first time. This number is alarmingly high and carries risks of poorer health outcomes for large swathes of the population.

‘Under the NHS constitution, 92% of patients should be treated within 18 weeks as part of the referral-to-treatment scheme. However, that target has not been met since 2016. The Covid pandemic, combined with widespread staff shortages and a decade of austerity funding, has left many hospitals with a growing backlog.’ 

Delays in treatment are unfortunately nothing new. The NHS has been underfunded and understaffed for some time and therefore entered the pandemic on unstable footing.

Chris Hopson, chief executive of hospitals group NHS Providers, has pointed out that NHS hospitals are now performing operations at 90% of pre-pandemic levels. This is ahead of the 75% goal set by NHS England. So, although the NHS is still behind and racing to catch up, it is gathering speed. Unfortunately, in order to actually clear the backlog we will need to surpass the pre-pandemic rate of surgeries. It is important that these figures do not deter anyone from seeking medical advice and help from the NHS and people continue to go to their GPs with any health concerns they may have.

Cancer care

The researchers behind these backlog statistics have warned that ‘some cancer patients will die as a result of widespread suspension of normal NHS care’. The co-lead author of the study, Tom Dobbs, stated that:

‘Delays in the diagnosis and surgical management of cancer patients will lead to an increase in deaths, while those waiting for semi-urgent and elective surgery are more likely to experience a worsening of their condition, with some procedures made more problematic and less likely to succeed.’

Cancers are most treatable when caught early, therefore delays are directly detrimental to patient outcomes. Delays in cancer diagnoses are not entirely down to the NHS, patients themselves may have postponed visiting the doctor about their concerns in order to not add any burden to the service.

Some cancer treatments, such as chemotherapy, can lower natural immunity which may make people wary of pursuing treatment a the moment if they are especially worried about the virus. Patients have been urged to continue pursuing and receiving care as normal, including receiving the coronavirus vaccine, while receiving cancer treatments. Cancer care has continued throughout the pandemic but, as has been seen throughout the NHS, services have been stretched thin.

Life on hold

Patients have described these long waiting lists as mental torture as they wait months for surgeries. It is not only elective procedures that are delayed – vital things like heart surgeries have been pushed back, leaving patients in terrifying positions as they hope their condition doesn’t worsen. The mental exhaustion of waiting adds on to the existing anxieties around undergoing complex and major surgeries.

These surgeries are not optional luxuries and are not something people should have to wait for; delays have very real health risks as well as carrying a considerable mental burden. Issues such as this immense backlog are the kind of thing lockdowns were implemented to avoid – though the NHS was saved from being overwhelmed by covid-19 patients, it seems that the pressure was simply delayed. These delays also carry a subsequent risk of worsened mental health in the population, adding to an already increased number of people seeking mental health support.

This is far from over

Although we may be beginning to get the virus under control, the wider effects of the pandemic are still only just being realised. Clearing these immense backlogs is going to be an enormous undertaking and it will take years for the NHS to recover. That recovery won’t be easy, especially with the alarmingly high levels of burnout among NHS staff and the continued funding issues that have haunted the service for years.

NHS staff have been working flat out for over a year now, unable to go much beyond limiting the damage of the virus. This time in damage control mode has wreaked havoc on their mental health and left no time or energy for tackling the patient backlog. One of the main post-pandemic challenges will be supporting NHS staff back to their full health so that they may continue to support the health of the nation.

Issues of funding have directly and indirectly caused treatment delays. Directly through lack of funding for individual surgeries, and indirectly through causing staff to leave their jobs in the face of mere one percent pay rises. Helping the NHS recover from the pandemic will be an extremely difficult task that will require a lot of support from the government. More funding and more staff are obvious requirements, but how to actually meet these goals will be a different question entirely.

Final thoughts

Seeing an actual solid figure of the number of surgeries that have been delayed is sobering. The outlook appears bleak and it is hard to find any positive notes to end on other than the fact the NHS remains standing (on albeit unsteady feet). The health service is certainly struggling, and will continue to for some time to come, but at least it has made it through that very dark winter.

About the Author: Leo Hynett

Leo Hynett is a contributing Features Writer, with a particular interest in Culture, the Arts and LGBTQ+ Politics.