'Unquantifiable challenge': Plans to tackle NHS backlog could be derailed by lack of staff, MPs warn

The “catastrophic impact” of the Covid pandemic on patients waiting for NHS treatment is clear, but plans to tackle it could be derailed by emergency care demands and a lack of staff, MPs have said.

The record number of people on the waiting list for planned care in England – almost six million – is likely to grow but, at the same time, the NHS is also dealing with a record number of 999 calls and long waits to be seen in A&E.

In its new report, the cross-party Health and Social Care Committee said that tackling the wider backlog caused by the pandemic is a major and “unquantifiable” challenge as it includes all the people who have yet to come forward for care.

It calls for a broad national health and care recovery plan embracing emergency care, mental health, GPs, community care and social care.

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MPs said NHS staff are under pressure and could quit unless they see “light at the end of the tunnel” in the form of more staff to help them deal with the pressures on the health service.

The report said: “Now, as we approach a third year living with Covid, the catastrophic impact on patients waiting for NHS care is becoming clearer.

“Of the 5.8 million patients waiting to start treatment in September 2021, 300,000 have been waiting more than a year and 12,000 more than two years.”

While MPs welcomed government funding to create an extra nine million checks, scans and operations, they said NHS England has yet to publish its plan on “how it plans to meet its workforce requirements”, despite this being promised by Health Secretary Sajid Javid by the end of November 2021.

They added: “During our inquiry, we heard many times that workforce shortages were the key limiting factor on success in tackling the backlog.

“Without better short and long-term workforce planning, we do not believe the nine million additional checks, tests and treatments will be deliverable.

“We note there are currently 93,000 vacancies for NHS positions and shortages in nearly every specialty.

“We remain unconvinced there are sufficient plans for recruitment and retention of staff. Our concerns also extend to the social care workforce, which has at present 105,000 vacancies and a turnover rate of 28.5%, rising to 38.2% for nurses working in social care.”

The report said MPs had previously recommended that Health Education England is forced to “publish objective, transparent and independently-audited annual reports on workforce projections that cover the next five, 10 and 20 years” but this had been voted down by the government when it came to making this law.

“This creates a gap between ministerial rhetoric about supporting frontline staff and refusal in practice to do the biggest single long-term change that would relieve the pressure they face,” the MPs said.

“Additionally, without such an independent forecast of future workforce needs, it remains impossible for anyone – including this committee – to know whether enough doctors, nurses or care staff are being trained.

“This is a significant accountability gap which prevents Parliament doing appropriate scrutiny”.

The report broadly welcomed wider use of the private sector to tackle the treatment backlog but said “given that its hospitals tend to be in more affluent areas, it is important to ensure that any use of such capacity does not exacerbate existing health inequalities given that the biggest increases in waiting lists are in the areas of greater deprivation”.

It also warned against creating a target culture which could have the unintended effect of compromising quality and patient safety.

MPs further raised questions over how effective the campaign to get people to call 111 first when they have an urgent, but not life-threatening medical need has been, saying there does not appear to have been an evaluation.

Health and Social Care Committee chairman and Tory MP, Jeremy Hunt, said: “The NHS faces an unquantifiable challenge in tackling a backlog of cases caused by the pandemic, with 5.8 million patients waiting for planned care and estimates that the figure could double by 2025.

“However, our report finds that the government’s recovery plans risk being thrown off course by an entirely predictable staffing crisis.

“Far from tackling the backlog, the NHS will be able to deliver little more than day-to-day firefighting unless the government wakes up to the scale of the staffing crisis facing the NHS, and urgently develops a long-term plan to fix the issue”.

Dr Adrian James, president of the Royal College of Psychiatrists, said: “The pandemic has had an enormous impact on demand for mental health services already struggling with chronic staff shortages.

“This perfect storm has created the largest mental health backlog in NHS history, with over 1.5 million people waiting for treatment”.

Dr David Wrigley, the British Medical Association’s deputy council chair, said: “This wide-ranging and detailed report clearly lays out what a gargantuan challenge the NHS faces.

“The biggest barrier to tackling the backlog caused by the pandemic is a severe staffing crisis and our calls for improved workforce planning have thankfully been heard. It’s now time for the government to listen too”.

Minesh Patel, head of policy at Macmillan Cancer Support, said: “After years of failing to deliver the long term funding and planning the NHS needs, the government must now urgently commit the resources required to support and grow the cancer workforce, so that it can tackle the backlog and provide urgent cancer care to everyone who needs it”.