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NHS England issues post-strike priorities as reality of reducing elective backlog becomes clearer

NHS trusts and integrated care boards must work to reduce elective long-waits and meet cancer 62-day backlog targets following this month’s strike action, NHS England has said.

In a letter addressed to chief executives and directors, NHS England outlined its expectations following the disruption caused by the junior doctors’ strike held in January.

It said that trusts will likely face a combination of pressures including seasonal Covid and flu presentations, cold weather-related presentations, staff sickness and the need to reschedule patients’ cancelled appointments.

NHS England urged trusts to ‘continue to prioritise the safety of patients’, including urgent planned surgery and other treatment for time-sensitive conditions, particularly fast progressing cancers.

It said the priorities from January to March remain for:

  • All systems to deliver at least 76% four-hour performance and Category 2 ambulance response times as committed to in quarter four in the November planning round, supported by continued delivery of actions identified as part of the Urgent and Emergency Care Recovery Plan
  • All systems and providers to deliver their cancer 62-day backlog reduction targets as well as achievement of the 75% faster diagnosis standard by March 2024
  • All systems to continue to reduce elective long-waits in line with the ambitions in the Elective Recovery Plan and activity levels agreed in the most recent planning exercise.

The latest round of junior doctor strikes lasted for 144 hours from 7am on 3 January to 7am on 9 January as part of their ongoing salary dispute.

NHS data showed that more than 113,700 inpatient and outpatient appointments due to be held during the strike had to be rescheduled.

Since strikes began, the cumulative total of acute inpatient and outpatient appointments rescheduled is now 1,333,221, according to NHS England.

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Reducing backlog and building resilience

As these latest NHS priorities were shared, a new study suggested that the NHS must treat 10% more non-urgent hospital cases a month to reverse the increasing waiting list for elective care.

Even if system capacity were to increase by 30% – as NHS England’s target sets out – it would still take ‘several years’ to clear the backlog, researchers from Universities of Edinburgh and Strathclyde said.

Published in The Lancet, the research paper estimated there were 10.2 million fewer referrals made to elective care between the beginning of the Covid-19 pandemic and October 2022.

It also highlighted that the NHS waiting list for elective treatment increased between January 2012 and 2020 suggesting ‘a gradual service decline’ even before the pandemic.

The researchers concluded that even if the 30% increase in capacity is achieved during the next three years, ‘several years (beyond the end of 2025) will be needed for the backlog to clear.’

They added: ’Our study emphasises the need to improve healthcare system resilience to ensure that the effects of any future emergencies on the provision of routine care are minimised.’

The most recent NHS England data revealed that the Covid-19 backlog has fallen for two months in a row, dropping by 95,000 individual pathways from 7.7 million in October to 7.6 million in November.

NHS England said this was due to NHS staff delivering more than 1.63 million treatments in November – the highest monthly activity on record and around 150,000 more than the same month before the pandemic.