Why the jury is still out on NHS backlog plans

Tackling NHS backlog is one of six key tasks for government – now Prime Minister Sir Keir Starmer said he had plans to end the situation.

But what is striking about this New Year waiting list announcement is how few levers ministers appear to have to pull.

Much of the plan builds on work already underway in England, and there are reasons why these policies have had limited impact so far.

The community has committed to building more surgeries and diagnostic centers – building on a network that started rolling out before the pandemic.

They allow more care to be provided outside hospitals, and the government wants to see not only more hospitals but also longer opening hours. But, of course, the key limiting factor is having enough staff to deliver treatment – something the British Medical Association points out.

Sir Keir also wants to make it easier for patients to choose where to go for treatment, with the idea being to enable them to shop around and go to places with the shortest waiting lists.

The policy goes back much further, introduced by the Blair government and subsequently supported when the Conservatives were in power. Still, only about a quarter of patients reported being given a choice. Even if that changes, the question remains of how many patients will be willing to travel elsewhere for care.

Another initiative, which has been in place for more than two decades, is to allow independent departments to reduce the burden on the NHS. The private sector says it has the capacity to handle 30% more NHS patients than currently.

But this policy comes at a cost – the private sector often takes only the most straightforward procedures, which can deprive NHS hospitals of vital revenue and doctors and nurses of vital training opportunities.

That's not to say the backlog won't decrease. It would be surprising if the decline didn't begin in the coming months – most forecasts identify this spring as a potential turning point.

But the ultimate goal of getting the NHS back to the 18-week target before the end of this parliament remains a big question mark.

This means 92% of patients will be treated within 18 weeks – a target that has not been achieved since 2015. Currently this number is less than 60%.

The Blair government made huge progress in the early 2000s, but it was based on huge increases in the NHS budget – 6-7% a year with inflation.

An increase of this magnitude seems unlikely given the state of public finances – although we will have to wait until the spending review in the spring to determine what budget will be set aside for the NHS in the coming years.

Another concern expressed by some is that with so much focus on waiting lists, other areas may end up being neglected because health chiefs focus too much attention on the issue.

Sarah Woolnough, head of the King's Fund think tank, said: “The 18-week target should not be seen as the only measure of NHS performance. “It is also important for people to wait for their GP appointment or hours for ambulances, mental health care and other services.”

In short, any progress made on the waiting list could easily be lost if the wheel fails elsewhere.