Key messages

• Before the pandemic, despite the NHS treating record numbers of patients, demand was outstripping capacity, placing pressure on performance standards, with a number of trusts recording their lowest results to date. This was in part due to increased demand, austerity funding, reduction in bed capacity, workforce shortages and a lack of capacity in social care.
• The NHS therefore entered the pandemic under severe pressures and is now facing a significant backlog of care across a range of services, including urgent and emergency care pathways, planned operations, mental health and community services, exacerbated by COVID-19. Trusts and frontline staff are working incredibly hard to bear down on this backlog, but there is ongoing uncertainty over how many people will continue to come forward in need of care, the number of hospital admissions due to COVID-19 hospitalisations in the future, and how quickly we can stabilise the urgent and emergency care pathway. All of these factors could have a significant impact on how quickly the NHS will be able to reduce waiting lists.
• The waiting list for elective care continues to grow. In October 2021, the elective care waiting list was 5.98 million, and treatment activity has remained below normal levels. NHS cancer services activity has recovered to pre pandemic levels. However, in September 2021 only 68% of patients requiring treatment within 62 days of urgent referral by their GP were receiving that treatment on time.
• Support to recover performance should include a fully funded long term workforce plan, further improvements to the NHS’s culture and ways of working, temporary and permanent capacity expansion, an increase in capital funding and investment in digital technology and transformation.
• Trust leaders have welcomed the government’s support during the pandemic and the recent three-year revenue settlement. But even with this extra funding, we must be honest with the public about the scale of the challenge ahead, and the length of time it will take for the NHS to address the backlog across services.
• The pandemic exacerbated the challenges facing both the NHS and social care pre-pandemic. Despite recent announcements and the health and care levy, the social care system is still in need of reform to ensure its sustainability and expand access for those with unmet needs.  We must therefore learn from the experience of the pandemic and be better prepared for future events. The underlying causes which led to the current unsustainable pressures the NHS and care system is facing must now be addressed.