To find out more about this issue, please read Patient Safety Learning's blog: Patient safety on the frontline: Responding to the treatment backlog safely

COVID-19 has placed the health and social care system under unprecedented pressure this year. To meet the demand created by the pandemic, a range of non COVID care and treatment was postponed at the peak of the crisis to free up capacity of the NHS. 

These decisions have created a long-term challenge, with a significant backlog in treatment and care.[1] Postponing all non-urgent elective operations for a period of three months is estimated as resulting in more than half a million cancelled procedures.[2] This, alongside other challenges to restoring services following the peak in the pandemic, could result in the waiting list reaching 10 million by the end of 2020.[3] 

Impact on patients

The delays in treatment resulting from this backlog will have a significant impact of patients’ quality of life and, in some case, their survival. 

For those managing chronic diseases, such as arthritis, long delays in fairly common surgeries (for instance knee replacements) can reduce functional capacity gain and lead to increased pain and disability.[4] Meanwhile, a recent study looking at delayed diagnosis and cancelled treatment for cancer cases during the pandemic suggested that this could result in “anywhere between 7,000 and 35,000 additional deaths from the disease over the coming year”.[5]

In addition to those waiting to be referred for treatment, there is also the issue of high numbers of patients waiting on follow-up appointment. Clinicians have expressed concerns about the clinical risk to those facing delays on their follow-up outpatient lists, particularly because the scale of this is hard to gauge due to there being “no official, verified data on follow up appointments”.[6]

Addressing the backlog safely

In its recent ‘Third Phase’ response guidance, the NHS identified one of its three key priorities as “accelerating the return to near-normal levels of non-COVID health services, making full use of the capacity available in the ‘window of opportunity’ between now and winter”.[7]

As we do this, it is vital that patient safety considerations are placed at the heart of this process, as the NHS seeks to address the backlog of cases while also meeting regular demand for services. Key points to consider include:

• How are organisations tackling the treatment backlog?
• How is access to treatment and care being prioritised?
• What are the risks to patient safety, and are these being addressed?
• Who will ensure that patients’ needs are considered, and who will provide information to manage patients’ expectations?
• Should cases where surgery delays lead to significant health issues, or even death, be considered as serious incidents?
• Do we have adequate data about the backlog so we can quantify the problem and manage waiting lists, whether referral to treatment or follow-up appointments?

Find out more - join the webinar

Are you interested in hearing more about these issues? The webinar is scheduled for 11.00am (BST) on Wednesday 16 September and you can sign up here.

References

1. Patient Safety Learning, Response to the Health and Social Care Select Committee Inquiry: Delivering Core NHS and Care Services during the Pandemic and Beyond, 8 May 2020; Patient Safety Learning, The return of elective surgery and implications for patient safety, 15 June 2020.
2. Estimates on this figure vary between around 516,000 at the lower end of the scale (University of Birmingham, COVID-19 disruption will lead to 28 million surgeries cancelled worldwide, 15 May 2020) to potentially as high as 749,248 (Alexander Fowler et al, Resource requirements for reintroducing elective surgery in England during the COVID-19 pandemic: a modelling study, medRxiv, 2020).
3. NHS Confederation, Public reassurance needed on slow road to recovery for the NHS, 10 June 2020.
4. Versus Arthritis, Written evidence submitted by Versus Arthritis (DEL0173), May 2020.
5. Health Data Research UK, The Big C isn’t COVID-19 – it’s cancer, 25 August 2020.
6. Health Service Journal, Recovery watch: the NHS' biggest restoration challenge, 2 September 2020.
7. NHS England and NHS Improvement, Third phase of NHS response to Covid-19, 31 July 2020.

View recording of the webinar

To read more about our top highlights and takeaways from the webinar, and how we're using your questions and concerns to shape our work in non COVID-19 care and patient and staff safety, please see our blog.

We'd love to hear more of your views and questions to help inform Patient Safety Learning's future webinars. Please share ideas for topics in our Community thread.