Effects of the COVID-19 pandemic on NHS England waiting times for elective hospital care: a modelling study

The COVID-19 pandemic led to unprecedented health-care disruption across the UK.1 In England, the number of patient referrals waiting to be treated in hospital was more than 7·2 million at the end of October, 2022.2 In response, the UK Government set up an elective recovery taskforce (ERT) in December, 2022, to help NHS England tackle this backlog.3

NHS England's recovery plan aims to increase capacity by up to 30%, compared with pre-pandemic levels, over 3 years through a range of measures, including extra staff and increased use of the independent sector.4 NHS England estimates that more than 10 million patients who might otherwise have come forward for treatment did not do so during the pandemic.4 There is, however, considerable uncertainty in how many of these missing people might actually come forward and also in the increase in capacity that could realistically be delivered. This uncertainty consequently is a challenge for the ERT when assessing the effects of the pandemic on the hospital elective waiting list and, importantly, deciding what increase in capacity is needed to reduce the backlog. We sought to understand these key knowledge gaps by investigating the effects of the pandemic on the waiting list for elective hospital care and by developing projections under different possible capacity-increase scenarios. Our aim was to estimate the extent of health-care disruption during the COVID-19 pandemic to aid decision making regarding the necessary capacity increases that are required to address the ensuing backlog.