Our position on elective care
Elective or ‘planned’ care refers to ‘non-urgent’ operations, appointments, or diagnostic tests for which people are referred to hospitals, including knee, hip or eye surgeries.
Waiting lists for elective care services were rising steadily before the COVID-19 pandemic, with more people joining the waiting list than were being treated, admitted or discharged.
Once the pandemic hit, the numbers on the list suddenly dropped, as appointments were cancelled or postponed. But once referrals restarted, the record for numbers on the elective care list was broken each month between October 2020 and November 2021.
As of December 2022, the NHS waiting list was at 7.20 million appointments. And instead of being seen within the statutory target of 18 weeks, 92% of people are now waiting up to 46.3 weeks.
Our research has highlighted the impact long waits have on patients, particularly those facing health inequalities. We have worked closely with decision-makers to help address barriers and improve experiences.
What we’re calling for:
- Improve NHS processes for contacting patients. NHS England accepted several Healthwatch recommendations in their Elective Recovery Plan. These included:
- Implementing the guide to good patient communications.
- Ensuring patients don’t feel forgotten by putting regular updates in place, across different communication channels.
- Improve the experience of waiting for care.
The Elective Recovery Plan also recognised our calls to:
- Improve the support people need while they wait, such as providing people with better access to pain management, physiotherapy, and mental health support.
- Provide support with transport and accommodation where patients choose to travel for quicker care at a specialist hub.
- Give people more control over their appointments. We have called for better options for people to feed back about their issues while waiting for elective care procedures. This includes making it easier for patients to update the NHS when there are changes in their condition, including allowing people to book, view or cancel their appointments through the NHS app. New features allowing this in the NHS app are now available to patients at 20 NHS trusts, with more trusts expected to make this available by March 2023.
Our evidence
We need to focus on inequalities to address waiting lists
Our 2021 research highlighted that long delays for treatment, last-minute cancellations, and a lack of personalised information and support were huge concerns for people, particularly for respondents from lower-income households.
Our follow-up research from 2022 further highlighted that these issues disproportionately affect certain groups.
- Disabled people, those with lower levels of wealth, women, and people from ethnic minority backgrounds are the most likely groups to have experienced long waits for treatment and a delay or a cancellation.
- Women and disabled people are also most likely to have been negatively impacted by their long wait for care, with relationships, socialising, ability to provide care for a loved one, and mental health and wellbeing suffering as a result.
- People with lower levels of education are more likely than people with higher education to be happy with the information the NHS has provided them.
- And for people whose identities intersect across several groups, the impacts of long waits can be much worse.
Our work
What action we have taken
We supported NHS England in the development of the Elective Recovery Plan and our recommendations informed commitments in that plan.
We have particularly encouraged the NHS to focus on inequalities in addressing backlogs. For example, we advocated the NHS to ensure that patients who are offered faster treatment away from their local hospital are having their transport and accommodation costs covered. Without this support, the option to be seen quicker would be limited to those who can afford it.
But until capacity can meet demand, long waits are here to stay. This is why we continue to call for a focus on ensuring people don’t feel forgotten while they wait.
This includes investing in NHS teams and hiring staff who can manage the important data and administrative work involved in supporting those on the waiting list.
We have also called for continued support for NHS teams to help them:
- Provide regular and proactive communications with patients, letting them know when they can expect to be seen.
- Prioritise those impacted by long waits, including support with pain relief and mental health support.
- Tackle the unequal access some face, ensuring that solutions supporting quicker access to care don’t exacerbate inequalities.
