The building backlog of NHS elective cases post Covid‐19

Abstract

Editor The current Covid‐19 pandemic faced by the healthcare system is unprecedented in the modern health care setting. The NHS has been re‐tasked to treat a large number of Covid‐19 patients, suspending the usual business of elective surgery 1 . There is no current estimate to the size of the backlog being generated. Calculating the scale of the backlog It is impossible to tell the exact scale of the cancellations ongoing as NHS statistics have ceased to record this data during the current Covid‐19 pandemic 2 . However, a rough estimate can be made from comparison of the statistics from 2019 for the same period. Using emergency admissions to calculate non‐emergency admissions, the percentage of finished consultant episodes (FCE's) requiring a procedure can produce an estimate of the number of non‐emergency admissions with procedure each month (Table  1 ). This data tallies with the known data of finished admission episodes (FAE's) by admission method. This gives an estimate of between 505 146 ‐ 574 353 admissions per month. Using the data from the hospital admission by specialty and eliminating all non‐surgical specialties and paediatric specialties we can see that there were 4 871 276 admissions that were ‘planned’ (1 335 565) or ‘waiting list’ (3 535 711). This gives us an estimate of 405 939 admissions per month for the surgical specialties, with an average bed stay of 4·3 days 3 . Even if we use a low end estimate of ∼400 000 cases per month, this will still lead to a back log of 1 200 000 cases over a 3‐month period. Table 1 Provisional monthly hospital episode statistics: admitted patient care data with addition of non emergency admissions requiring a procedure estimate 6 , 3 . 2019 Finished consultant episodes FCEs with a procedure % FCEs with a procedure Ordinary episodes Day case episodes Day case episodes with a procedure % Day case episodes with a procedure Finished admission episodes Emergency admissions Non emergency admission with procedure Oct 19 1,840,455 1,009,412 54.8% 1,166,818 673,637 600,033 89.1% 1,525,178 565,326 526,438 Sep 19 1,725,979 1,015,939 58.9% 1,105,315 620,664 582,690 93.9% 1,428,181 535,056 525,708 Aug 19 1,713,472 1,012,009 59.1% 1,108,339 605,133 568,563 94.0% 1,414,682 532,720 520,903 Jul 19 1,846,274 1,101,264 59.6% 1,172,130 674,144 633,149 93.9% 1,526,850 563,945 574,353 Jun 19 1,709,597 1,010,989 59.1% 1,102,241 607,356 571,396 94.1% 1,414,451 531,335 522,240 May 19 1,800,193 1,060,876 58.9% 1,161,064 639,129 601,609 94.1% 1,483,667 560,004 544,326 Apr 19 1,725,301 1,004,293 58.2% 1,121,169 604,132 569,322 94.2% 1,413,927 546,124 505,146 These patients who wait may have a significant reduction in quality of life. Patients who have had multiple attacks of cholecystitis end up staying in hospital a week longer 4 whereas those who wait too long for a joint replacement see a significant reduction in benefit 5 . The scale of the backlog should not just be seen as an increased waiting list but a ticking cluster bomb throwing off explosions of poor patient outcomes as time progresses. Conclusions Resumption of service to approaching normal will take months if not years and will result in a large backlog of elective cases. Strategies for resumption of work differ between college and specialty with new guidelines being produced on a weekly basis. We estimate across the NHS circa 400 000 procedures are backlogging per month. Resumption of services will be slow and less time efficient than pre‐pandemic. Unless the government recognizes this paradigm shift in treatment and responds appropriately the current measures will result in large fines being levied on NHS trusts and poor outcomes for patients left waiting. We believe the large backlog of elective cases which will have a real impact on patient care and wellbeing. Ongoing waiting times must be adjusted to provide reasonable expectations to patients and allow critical cases such as cancer diagnostics to proceed in a timely manner. Strategies to reduce waiting times include continued investment in private hospital capacity, expansion of the workforce and increase in conservative management strategies. Finally, a national level response is needed to prevent ‘post code lotteries’ and could be used to redistribute workload evenly amongst the workforce.