A survey of trust leaders by NHS Providers has revealed widespread worries that rapidly growing waiting lists will worsen existing health inequalities.

All trust leaders who responded said they were concerned, including 66% who were very concerned.

The findings come amid growing evidence of the damaging impact of the pandemic on health inequalities, as highlighted recently by NHS Providers' recent report: Health inequalities: A core concern.

They also reflect concerns about the time it will take to recover the care backlog, despite impressive progress by trusts and frontline staff in restoring services. Almost a third of leaders (32%) said  it will take three to five years.

These findings come ahead of the publication later today of the latest NHS performance data, which are expected to confirm the unrelenting pressure on the health service as we head into winter.

A record 5.6 million people are currently on waiting lists for planned procedures with over 1.5 million waiting to access mental health services. Urgent and emergency care services face incredibly high demand with similar pressures across community services.

Trusts and frontline staff are working incredibly hard to bear down on the backlog of care but this survey highlights the growing scale and complexity of demand.

As part of our submission to the National Audit Office inquiry on NHS backlogs and waiting times, our survey of 170 trust leaders from 119 trusts (56% of the provider sector) found:

• Most trust leaders (66%) were very concerned that backlogs in care will further exacerbate health inequalities.
  
  
• Mental health services (specifically children and young people's and eating disorders), urgent and emergency care and cancer services top trust leaders' concerns.
  
  
• 87% of trust leaders said they were now seeing patients with more complex and acute needs compared to before the pandemic with figure reaching 94% for mental health and learning disability trusts and 91% for community trusts.
  
  
• 96% of respondents stated that the current level of demand was significantly increasing (64%) or moderately increasing (32%) across all services provided. This figure was 100% for ambulance trusts and 96% of community service.
  
  
• Almost one third (32%) of respondents felt that it would take three to five years for their trust to tackle the backlog of care.

Commenting on the survey results, the deputy chief executive of NHS Providers, Saffron Cordery said:

"Our survey reveals the sheer scale of the challenge that trusts are now managing. Trust leaders are fighting fires on multiple fronts as they try to recover care backlogs, deal with increased demand for emergency care, treat patients with COVID-19 and prepare for what is likely to be the most challenging winter yet for the NHS.

"In a matter of weeks, we will face our first winter where both flu and COVID are in circulation. NHS staff are doing all they can to bear down on the care backlog, but the reality on the frontline is that even a small increase in flu, COVID-19 admissions or emergency care attendance will really increase the pressure on the service.

"The impact the care backlog could have on worsening health inequalities weighs heavy on the shoulders of trust leaders. It is hugely reassuring then that they are working with partners across the health and care system to manage waiting lists to prioritise the sickest patients. It is reassuring that a quarter of trusts said an ICS wide approach to managing waiting lists had been extremely or very helpful in tackling health inequalities.

"It is also positive to hear trust leaders are using digital innovations such as the continued use of virtual appointments where appropriate, and digital transformation of some manual processes to reduce the administrative burden on clinicians, freeing up more time to care for patients and to increase elective activity and manage waiting lists.

"But the key intervention NHS leaders tell us they need is new staff to support their plans. We must not forget that the service entered the pandemic with over 100,000 workforce vacancies. We need a fully costed and funded multi-year workforce plan sooner rather than later."