NHS Surgery Waiting Lists Reach Peak Levels

As of the time of writing this article, 66,713 people have died in the UK with COVID-19 on their death certificate. This does not mean that all of those people died as a result of the virus, but it may have been a contributing factor. When we look back on this time, we will inevitably have a better perspective on the true impact on our society of Coronavirus. It is likely that one of these impacts which will become increasingly apparent is that the virus will have caused considerable indirect harm. That is to say, for all of those who died with a diagnosis of COVID-19, many others have had their treatment for other conditions interrupted by the pandemic or simply not been diagnosed, leading to serious health outcomes. As an early sign of this, the NHS is already reporting a huge backlog in elective surgery cases. In this article, we will take a look at the indirect health impact of the COVID-19 pandemic in the UK, including on those waiting for urgent surgery and cancer diagnosis.

NHS Surgical Waiting Lists Now a Real Cause for Concern

One of the harsh realities of the first COVID-19 wave and lockdown was that non-essential surgery across the UK was postponed to ensure sufficient capacity in our hospitals. An article in the British Medical Journal (BMJ) published on 11^th September 2020, entitled ‘Covid-19: Waiting times in England reach record highs’, looked at the situation. It found, “More than 83 000 patients in England waited more than a year for NHS treatment in July, the highest number since October 2008 and an 81-fold increase from 1032 in July last year, latest figures have shown”. The analysis also found that those on waiting lists for more than 18 weeks as of July 2020 was at the highest level since records began in 2007, at 2.15 million. Under 47% of patients were treated within the 18 week target (this is supposed to be no less than 92%). Neil Mortensen, president of the Royal College of Surgeons of England expressed his concern and frustration with the situation; he said “We urgently need to build up our hospital reserves if we are to see this winter through. Flu, together with continuing local covid-19 outbreaks, must not bring surgery to a standstill again, or thousands more will suffer”.

The impact of COVID-19 on Cancer Treatment

One of the primary concerns is that many patients with cancer may have gone undiagnosed in recent months, and this may have reduced the chances of recovery for some. This is a concern echoed by Sara Bainbridge, head of policy at Macmillan Cancer Support, who is quoted by the BMJ as saying “delays could directly impact on many of these people’s chances of survival . . . causing huge amounts of distress to them and their loved ones”.

Cancer Research UK undertook an analysis of the impact of COVID-19 on cancer treatment in September 2020. According to their assessment, cancer screening was hugely impacted with bowel, breast and cervical screening programmes being put on hold during the first lockdown. On the basis that 210,000 people are screened in the UK each week, the screening waitlist ballooned to in excess of three million people, a truly concerning statistic. As the charity point out, however, “The good news is that some programmes have now restarted in some way. But given the number of people needing to be screened, it may be some time before they are back on track. And as health is a responsibility for each Government across the UK, timelines for restarting will be slightly different in each UK nation.

Getting screening up and running and addressing the backlog poses significant and unique challenges for each programme”. The challenge for screening services is now how to clear the backlog while prioritising those who received an abnormal screening result prior to the lockdown. Screening capacity is also reduced due to the additional cleaning which is required for medical equipment between each patient.

In terms of cancer diagnosis, Cancer Research UK estimates that around 350,000 fewer people than expected were referred for urgent cancer symptoms between April and August 2020. In part, this is because fewer people went to their GP but also because some GPs were reluctant to refer patients to already busy hospitals. The latest numbers show a slow return to more normal levels of urgent cancer referrals, but they are still not at pre-pandemic levels. While this is postive, as Cancer Research point out, they would need to exceed pre-pandemic levels to ensure the full backlog of urgent referrals are dealt with. With every month that passes without a diagnosis and treatment, patients are put at higher risk of cancer spread and potentially reduced lifespan. Diagnostic procedures such as endoscopies, which are essential in the diagnosis of a whole range of gastrointestinal cancers are still well below the number carried out pre-lockdown. Over 60,000 gastroscopy procedures were carried out in January, versus around 30,000 in July 2020.

All of this is having a knock-on effect on treatment, with those who are yet to be diagnosed unable to start. It is estimated that approximately 37% fewer people were able to start treatment for cancer in England in May compared to the previous year. More recently this has recovered, but it is still around 24% lower.

Final words

Behind every statistic and percentage point are thousands of patients, and even more family members who will have their lives devastated by not receiving medical treatment when it is needed. The cruel reality of COVID-19 is that it doesn’t just harm those who are diagnosed, it also impacts those unable to receive the treatment or surgery they need. While numbers are starting to improve, there is only so much the NHS can do to catch up and mitigate the impact of the pandemic.