The NHS backlog as of August 2021

Yesterday (25/10/2021) it was announced that the NHS would receive an additional £5.9 billion in funding in an attempt to improve the state of the backlog[1]. This blog will share high-level insights and analysis on the most recent referral to treatment (RTT) data made available (August 2021).

Key highlights include:

  • The waitlist has continued to grow to 5.4 million patients (a 28% increase on the pre-COVID waitlist).

  • The total time waited for treatment has doubled from 44 to 88 million weeks waited.

  • There is an unobserved backlog of patients who are not on the waitlist but require treatment

RTT referrals dropped considerably throughout the pandemic. Since the lifting of restrictions, they have begun to recover and even briefly exceeded their pre-COVID levels in June 2021 by 2.1% however this was short-lived. Since then, referrals have fallen short. This could be for several reasons such as limited GP access or the resurgence of COVID admissions.

Due to decreased elective activity throughout the pandemic, the waitlist has grown from 4.2 million in February 2020 to 5.4 million in August 2021 (a 28% increase).

Not only has the waitlist grown in the total number of patients, but patients are also spending longer on the waitlist. In February 2020, 3.5 million patients (83% of the waitlist) had been on it less than 18 weeks, with 730k patients (17% of the waitlist) waiting over 18 weeks and only 1.6k (<<1%% of the waitlist) waiting over 52 weeks. Compare this to the current waitlist, where 3.6 million patients (67% of the waitlist) have been on it less than 18 weeks, with 1.5 million patients (28% of the waitlist) waiting over 18 weeks and 280k million (5% of the waitlist) waiting over 52 weeks.

Waiting over 52 weeks for a needed operation is bad enough, however, a small pocket of patients (nearly 10,000) are waiting over 2 years for treatment. More patients are waiting 2 years for treatment now than there were waiting 1 year for treatment in February 2020.

The number of patients waiting 52+ weeks for treatment reached its highest point in March 2021 of 410k patients. Until July, this was steadily decreasing despite expectations and dropped to 280k patients (32% decrease). Over August this did not drop much further, which means just as many 52+ week waiters were treated as the number of patients who became 52+ week waiters.


Despite long waiters making their way off the list, the overall time waited for treatment within the NHS continued to grow. Whilst the waitlist has grown by 28%, the total number of weeks waited has increased from 44 million to 88 million, it has doubled.

In addition to the increase in the observed waitlist and the amount of time waited, an unobserved waitlist is beginning to build. Over the last 17 months, there were over 7 million missed referrals compared to previous years referral figures. If even 25% of these return the waitlist could grow to over 7 million patients.



Throughout the pandemic, the waitlist for elective treatment has grown by 28%. The total time waited has doubled with 5% of the waitlist waiting an entire year for treatment they require. In addition, there is a backlog of patients who require treatment yet aren't on the waitlist. This will result in additional pressure to elective treatment waiting times.


[1] Gillett, F & Bowden, G, Budget 2021: NHS in England to receive £5.9bn to cut waiting lists - BBC News

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