Patients facing postcode lottery for routine operations, watchdog warns

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More than 9 million referrals to the NHS could be missing, while patients face a “postcode lottery” for cancer treatment and routine operations, a parliament watchdog has warned.

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Millions of patients have either avoided or been unable to access healthcare during the pandemic, leaving the NHS with a potentially unknown backlog of operations, which could increase the national waiting list to 12 million by 2025.

A report from the government’s National Audit Office warned on Wednesday that patients across England are facing a postcode lottery, with some hospital waiting lists far larger than others after the pandemic.


The findings come ahead of the government’s plan to tackle the NHS’s treatment and surgery backlog, which is expected to be published this week. In November, the NHS recorded its highest ever waiting list of 5.8 million.

NHS services in Birmingham and Solihull have the longest waiting lists, with 51 per cent of patients waiting longer than 18 weeks, compared to 20 per cent in Surrey, according to an analysis by NAO.

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Birmingham and Solihull also had the worst cancer wait times, with 57 percent waiting longer than three months, compared to Surrey, Kent and Cornwall, according to the data.

The NAO said the variations may reflect differences in the region, such as poverty levels and rates of routine operations prior to March 2020, as well as the direct impact of the pandemic.

NHS data in November showed the number of patients waiting more than two years for treatment after referral rose to 12,491.

The report also estimated that there were between 240,000 and 740,000 “missing” urgent GP referrals for suspected cancer patients between March 2020 and September 2021, and that 60,000 patients lost primary treatment during the same period.

The NAO warned: “The NHS was overworked year-on-year before the pandemic, but demand for its services was growing even more rapidly. To keep pace, it would either need more beds and more staff or work.” A different way of doing it would be needed, or most likely a combination of all three.”

When Covid-19 first hit England, the NHS agreed a deal with 27 private sector hospitals to continue operating regularly, fearing hospitals would be overwhelmed.

According to the NAO report, under this national contract, during 2020-21, the NHS will pay £2.1 billion to private sector providers in exchange for 3.3 million completed treatments.

Between March 2019 and February 2020, independent providers made up eight per cent of routine operations for the NHS.

After the pandemic the NAO said there was a “sharp” reduction in operations carried out by private sector hospitals in the early stages of the pandemic, but it rose to pre-pandemic levels from June 2021.

It is unclear how many operations and treatments were expected to be performed by private providers under the £2.1bn contract, and NHS England has never officially released this information.

However, in November last year health service journal Just a third of the capacity paid for by the NHS in private hospitals was used after the first pandemic wave.

Eve Byrne, Head of Campaigns and Public Affairs at Macmillan Cancer Support, said: “This report confirms what we hear from people living with cancer on a day-to-day basis. Chronic staff shortages are already having a devastating impact on cancer patients. and we have major concerns that are going to get worse without immediate action.

He said the government’s plan to tackle the operation backlog should be supported by steps to ensure adequate nurse staff.

“Without these important pieces of the puzzle, we risk an increasing number of people facing later diagnosis, poor care, and potentially poorer chances of survival. This has to change,” she said.

As part of the recommendations the NAO has said that the government, NHS England and education body Health Education England should develop a detailed plan to address the staff shortage over the next 12 months to three years.

The recommendation comes after the government rejected an amendment to the Health and Care Bill by MP Jeremy Hunt that would require the Secretary of State for Health and Care to publish an independent assessment of the NHS workforce gap every two years.

Dr Tim Mitchell, Vice President of England’s Royal College of Surgeons, said: “The NHS faces great challenges as staff treat COVID-19 patients while trying to reduce huge waiting lists for planned care continue to do.

He called for the government’s upcoming plan to include guidance on how it would set up “surgical hubs” and allow planned surgeries, separate from emergency care, to continue safely during the pandemic.

The Vice President of the Royal College said: “We also urge the Government to amend the Health and Care Bill to ensure that there are independently verified assessments of workforce numbers. Surgical interventions to bring wait times to acceptable levels are in place. Investments have to be made in both the hub and the employees.”

An NHS spokesman said: “Having treated more than half a million patients in hospital for Covid as well as delivering a world-leading vaccination program has inevitably impacted some routine and non-urgent care, yet Ever since the pandemic started the NHS. Have performed millions of routine procedures and over 450,000 people started cancer treatment.

“NHS staff are now pulling out all stops to recover to alternative activity levels, making good use of additional resources to open new surgical hubs and diagnostic centres, develop new ways of working and more operations, There are tests, tests and scans going on, so anyone who is concerned about their health should come forward so the NHS can help you.”


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