Managing the backlog

Covid-19 reduced NHS capacity and led to demand for services plummeting. The recovery could be more challenging than the crisis. 

This is our page on our independent analysis, insight and support for the NHS on the growing NHS backlog. If you have any questions, suggestions or feedback in general, please contact George at or 07980804956.


  • Before the Covid-19 crisis, around 4.5 million patients were waiting for treatment across NHS Trusts in England (Feb 2020).

  • On the 13th of March we published our initial assessment of the potential impact of Covid-19 on the NHS, which highlighted the substantial lack of critical care beds.

  • On the 17th of March, NHS England and NHS Improvement issued advice to Trusts. This included guidance on the postponement of all non-urgent elective operations from 15th April at the latest for a period of at least three months. 

  • Our initial modelling in April estimated that the waiting list would grow to around 7 million by 2021.

  • The crisis cased by Covid-19 has now largely passed and most hospitals are seeking to return to 'normal', although increased infection control measures (e.g. mandatory PPE and cleaning) has led to a substantial decline in surgical productivity (fewer operations per day) - around a 30% reduction. 

  • Our latest modelling based on data published in July 2020 shows that as of May 2020:

    • People on the official NHS waiting list had waited in excess of 52 million weeks.

    • A drop in demand and access to General Practice led to 2.9 million fewer new RTT referrals.

    • In 2020 to May, there have been 590 thousand fewer treatments and 1.2 million fewer outpatient consultations.

    • Over 26,000 people had waited longer than 52-weeks - a x16 increase in the number waiting in February.

    • The combination of a long waiting list pre-Covid-19, a reduction in activity during the Covid-19 crisis, a slow recovery in referrals for treatment, and a substantial drop in operating productivity means that waiting times will dramatically increase over the next few months.

    • If 100% of the "missing" activity returns, the waiting list will grow to over 10 million by April 2021 - this drops to 8.7 million if 50% of the backlog returns.

  • To date, there are no clear indications of how the NHS as a whole will manage the backlog.

  • Guidance from the Royal College of Surgeon's outlines prioritisation criteria for patient being referred for treatment, while essential in the short run this approach needs to be better understood in the longer term as it could amount to rationing.

​Updates will follow. 

Key stats - May 2020

52 million 

Weeks waited by people on the official NHS waiting list

10 million

Estimated size of waiting list by April 2021


People waiting more than 52 weeks for their operation 

Related work

The second wave is testing
There were less than 1,000 positive Covid-19 cases per day over the summer. In September this jumped to nearly 3,000 per day, it is now near
Understanding the risks of the second wave of Covid-19
Understanding the risks of the second wave of Covid-19 on the NHS
The risk to the NHS of a Covid-19 winter
The NHS was largely not overwhelmed by Covid-19 in April. But it did become a National Covid Service.
Regional impact of Covid-19 on waiting lists
The NHS entered the Covid-19 crisis, with over 4.4 million people on the waiting lists for NHS funded treatment – about 8% of the population
The NHS backlog
The number of people waiting more than 52 weeks has increased (see chart below) - from 1,613 in Feb to 26,029 in May (x16)
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