Summarising the effects of a post-pandemic backlog and staff shortage that is putting hospitals into crisis.

Impact of Covid

The pandemic forced the NHS in England to suspend much of its normal hospital activity and encourage people to stay away from hospitals. Beds that would have been used for routine activity were repurposed for Covid patients as hospitals struggled to meet the demands of each successive wave. As a result, the number of outpatient appointments, diagnostic tests, and elective procedures all declined sharply in 2020/21.  

By any reasonable measure, hospitals are in crisis: the proportion of people waiting more than 4 hours at A&E is the highest on record, ambulances are taking longer to respond to calls than at any time since the NHS started publishing data, the waitlist for elective care is the highest it has ever been and is not expected to start coming down until 2024. Covid alone is not to blame. This performance comes in the wake of more than a decade of below-trend spending increases.

Increase in spending

Spending on NHS providers – which includes NHS acute trusts, ambulance, community and mental health services – increased by 10.4% in real terms between 2019/20 and 2020/21. This was the first year of the pandemic and was the biggest single year spending increase since 2009/10. It is likely that there will be continuing Covid-related spend in the medium- to long-term, with the NHS Confederation and NHS Providers estimating between £4-5bn per year for some years to come. 

Increasing backlog

Hospital activity dipped during the pandemic and has not returned to trend levels. By July 2022, the elective backlog had grown to 6.8m people, its highest ever level. People are also waiting longer for procedures. The proportion of the waitlist seen within 18 weeks of referral from a GP fell to 61%, its lowest level outside of the first months of the pandemic and far below the NHS’ target of 92%. 2021/22 is also the first time that patients have waited more than 2 years for treatment since at least 2010, with 2,885, people still in this category by the end of July 2022. 

Staff shortage

After a decline in vacancies during the first year of the pandemic, the proportion of unfilled roles in the NHS workforce has increased. In the quarter to the end of June 2022, nursing, medical and total vacancies rose to 11.8%, 7.3% and 9.7% respectively. This overall figure is the highest level of vacancies since at least June 2017. Estimates suggest there is a shortage of 12,000 hospital doctors and 50,000 nurses and midwives in England.

The number of voluntary resignations also increased to 139,862 in 2021/22, up from 98,878 in 2020/21 with uncompetitive pay also worsening retention. The government has accepted the NHS pay review bodies’ recommendations for a pay uplift in full. The increase, however, is unfunded, meaning it will have to come out of the existing NHS settlement and could cost an extra £1.6bn-£2.4bn. 

NHS vacancy rates