Building back inclusively: radical approaches to tackling the elective backlog

Key points

• The number of people waiting for planned NHS care in England has grown to record levels, with more than 5.6 million people currently on the waiting list and over 7 million ‘missing patients’ anticipated to come forward for treatment.
• Inequalities are now becoming evident in the backlog, with evidence suggesting that waiting lists have grown more rapidly in more deprived areas during the pandemic. These areas could face disproportionately large waiting lists per head of population, and deprived communities could also have larger numbers of ‘missing’ patients.
• There are good reasons to believe that the current approach to elective care, whereby patients are treated in the order they present for care, exacerbates inequalities, worsens health outcomes and perpetuates the inverse care law. If the NHS is to restore services inclusively, radical action is now needed. This briefing sets out a package of measures.
• These include the politically uncomfortable step of proactively growing the waiting list; reforming constitutional standards; promoting active waiting; and developing tools to scan for early symptoms of life-threatening conditions as part of routine interactions with patients, among other measures.
• Alongside this, it will be important for the government to affirm its commitment to openness, transparency and public engagement, being realistic with the public about the demands on the service, the importance of seeking care promptly, and why prioritisation is important to protect the most vulnerable and improve overall outcomes.
• This briefing, informed by a roundtable of senior healthcare leaders convened by the NHS Confederation and Boehringer Ingelheim in summer 2021, recommends systemic action to tackle the elective backlog inclusively.

Boehringer Ingelheim has worked in partnership with the NHS Confederation to deliver this roundtable discussion. This report was prepared by the NHS Confederation and the opinions expressed within this report are those of the roundtable attendees and do not necessarily reflect the view of Boehringer Ingelheim or the NHS Confederation.