# NHS Waiting Lists Hit Record 7.8 Million as Winter Crisis Looms

> NHS England data shows waiting lists have reached a record 7.8 million patient pathways, with over 400,000 people waiting more than a year for treatment. Staff shortages, industrial action, and post-pandemic backlogs continue to strain the health service as winter approaches.

*Section: News — By Daily Junction Editorial Team (Newsroom) — Published October 15, 2024 — 9 min read*

Canonical URL: https://dailyjunction.org/news/nhs-waiting-lists-hit-record-high-2024
Tags: NHS, healthcare, waiting lists, public health, UK health policy

## Key takeaways

- NHS waiting lists in England reached 7.8 million patient pathways in September 2024, the highest on record
- Over 400,000 patients have been waiting more than 52 weeks for treatment, breaching the NHS constitutional standard
- Emergency department performance has deteriorated, with only 65% of patients seen within 4 hours against a 95% target
- Staff vacancies stand at 112,000 full-time equivalent posts across the NHS, with nursing and medical roles most affected
- The NHS faces a projected £14 billion funding gap by 2030 without significant investment or reform

The **NHS waiting list crisis** has reached unprecedented levels, with **7.8 million patient pathways** recorded in September 2024 according to NHS England's latest Referral to Treatment (RTT) data. Over **400,000 people** have been waiting more than a year for treatment, and emergency department performance has fallen to its lowest level outside of the pandemic, with only **65% of patients** seen within the four-hour target. The crisis is driven by a toxic combination of post-pandemic backlogs, chronic staff shortages, industrial action, and rising demand from an ageing population. As winter approaches—traditionally the most challenging period for the NHS—health leaders warn the service is at breaking point, with patient safety at risk and staff morale at an all-time low.

## The scale of the crisis

The headline figure of **7.8 million waiting** represents individual patient pathways, not unique patients—some people are waiting for multiple treatments. However, even accounting for this, NHS England estimates around **6.2 million individuals** are on waiting lists, approximately **11% of the English population**.

The breakdown reveals the depth of the problem:

- **400,000+ patients** waiting over 52 weeks (one year) for treatment, breaching the NHS constitutional standard that 92% of patients should start treatment within 18 weeks
- **62,000 patients** waiting over 78 weeks (18 months)
- **Average wait time** for non-urgent treatment has increased from 9.4 weeks in 2019 to 14.2 weeks in 2024
- **Cancer waiting times** show only 68% of patients starting treatment within 62 days of urgent GP referral, against a 85% target
- **Diagnostic waits** have improved slightly, but 22% of patients still wait over 6 weeks for key tests like MRI and CT scans

The specialties with the longest waits are **orthopaedics** (joint replacements, spinal surgery), **ear, nose and throat (ENT)**, **ophthalmology** (cataracts, glaucoma), and **dermatology**. These are often conditions that significantly impact quality of life but are not immediately life-threatening, making them vulnerable to repeated delays.

## Emergency care in crisis

While elective waiting lists dominate headlines, **emergency care** performance has deteriorated sharply. In September 2024:

- Only **65% of patients** were seen within 4 hours in A&E, against the 95% constitutional standard
- **13-hour waits** for admission from A&E have become routine at many hospitals
- **Ambulance handover delays** (over 30 minutes) occurred in 28% of cases, leaving ambulances queued outside hospitals unable to respond to new emergencies
- **Bed occupancy** averaged 94% across acute trusts, well above the 85% level considered safe for quality care

The Royal College of Emergency Medicine estimates that **14,000 excess deaths** in 2023 were associated with long A&E waits, based on analysis of mortality data and wait times. While causation is difficult to prove definitively, the correlation between deteriorating emergency performance and excess mortality is stark.

## The staffing crisis

**Staff shortages** are the single biggest constraint on NHS capacity. As of September 2024, NHS England reported:

- **112,000 full-time equivalent (FTE) vacancies** across all staff groups
- **Nursing vacancies** at 44,000 FTE, despite record international recruitment
- **Medical vacancies** at 9,500 FTE, concentrated in emergency medicine, psychiatry, and general practice
- **GP workforce** has shrunk by 1,800 full-time equivalent GPs since 2019, despite rising patient demand

The **vacancy rate** of 8.2% means that for every 12 staff the NHS needs, one post is unfilled. This creates a vicious cycle: existing staff work longer hours to cover gaps, leading to burnout and higher attrition, which worsens shortages.

**Industrial action** has compounded the crisis. Junior doctors and consultants took strike action on **32 days** between March 2023 and September 2024, the longest period of industrial action in NHS history. While disputes have now been resolved with pay settlements, the strikes led to an estimated **1.2 million cancelled appointments and procedures**, adding to the backlog.

**Retention** is as critical as recruitment. NHS staff survey data from 2024 shows:

- **42% of staff** report feeling burnt out
- **28%** have considered leaving the NHS in the past year
- **Staff sickness absence** has risen to 5.1%, the highest on record, driven by mental health conditions and musculoskeletal problems

## The post-pandemic backlog

The **COVID-19 pandemic** suspended routine elective care for months in 2020 and 2021, creating a backlog that has proven far harder to clear than anticipated. During the first wave (March-June 2020), **routine surgery was almost entirely suspended**, with only cancer and urgent cases proceeding.

While the NHS resumed elective care in summer 2020, subsequent waves and infection control measures (requiring longer gaps between procedures, reduced theatre capacity) meant activity remained below pre-pandemic levels throughout 2020-2022.

NHS England's **Elective Recovery Plan**, published in February 2022, aimed to eliminate waits over 18 months by April 2023 and return to the 18-week standard by March 2025. Progress has been slower than planned:

- **78-week waits** were eliminated by April 2023 (target met)
- **65-week waits** were supposed to be eliminated by March 2024 but stood at 15,000 in September 2024 (target missed)
- **52-week waits** were supposed to fall to pre-pandemic levels (around 1,600) by March 2025, but remain at 400,000 (target will be missed)

The **Nuffield Trust**, an independent health think tank, estimates the NHS will not return to the 18-week standard until **2026-2027** at the earliest, and only if funding increases and workforce grows as planned.

## Rising demand and demographic pressure

Even without the pandemic, the NHS would face rising demand. The UK population is **ageing rapidly**:

- The **over-65 population** has grown from 9.2 million in 2010 to 12.6 million in 2024, a 37% increase
- The **over-85 population** has grown from 1.4 million to 1.9 million, a 36% increase
- People aged over 65 account for **16% of the population** but **50% of hospital bed days**

**Multimorbidity**—having two or more long-term conditions—affects **27% of adults** and is strongly age-related. Managing multimorbidity requires more GP appointments, specialist input, and hospital admissions.

**Obesity rates** have risen from 26% in 2010 to 29% in 2024, driving increases in type 2 diabetes, cardiovascular disease, and joint problems requiring surgery. **Mental health demand** has surged, particularly among young people, with referrals to Child and Adolescent Mental Health Services (CAMHS) up 60% since 2019.

## The funding gap

The NHS budget has grown in real terms, but **not fast enough** to keep pace with demand. NHS England's budget for 2024-25 is **£165 billion**, a real-terms increase of 3.6% on 2023-24. However:

- **Historical trend growth** for the NHS averaged 3.7% per year from 1948 to 2019, suggesting current funding is barely keeping pace with long-term norms
- **Demand growth** is estimated at 4-5% per year when accounting for demography, technology, and rising public expectations
- **Productivity** has fallen since the pandemic, with the NHS producing 10% less activity per pound spent than in 2019, according to Office for National Statistics data

The **Health Foundation**, another independent think tank, projects the NHS will face a **£14 billion funding gap by 2030** if current trends continue. This assumes demand grows at 4% per year and productivity returns to pre-pandemic levels—if productivity does not recover, the gap could reach £20 billion.

## Government response

The **Labour government**, elected in July 2024, has made NHS recovery a priority. In the **Autumn Statement 2024**, Chancellor Rachel Reeves announced:

- **£8 billion additional funding** over two years specifically for elective recovery
- **£2 billion capital investment** in diagnostic equipment and surgical hubs
- A commitment to recruit **10,000 additional nurses and midwives** and **8,000 GPs** by 2029
- A **10-year NHS plan** to shift care from hospitals to community settings and increase prevention

Health Secretary **Wes Streeting** has been blunt about the scale of the challenge, stating in October 2024: "The NHS is broken. Waiting lists are at record highs, staff are burnt out, and patients are suffering. We will fix it, but it will take time—this is a 10-year project, not a quick fix."

The government has also commissioned **Lord Darzi**, a surgeon and former health minister, to conduct an **independent investigation** into NHS performance. His interim report, published in September 2024, concluded that the NHS is in "critical condition" due to underinvestment in capital (buildings, equipment) and workforce over the past decade.

## What patients can do

For individuals on waiting lists, options are limited but include:

**1. Patient Choice**: Under NHS rules, you can choose to be treated at any qualified provider, including private hospitals contracted to the NHS. Ask your GP or consultant if alternative providers have shorter waits.

**2. Clinical prioritisation**: If your condition worsens, contact your consultant's secretary to request re-assessment. Urgent cases are prioritised.

**3. Community alternatives**: For diagnostics (scans, tests), ask if community diagnostic centres have shorter waits than hospital-based services.

**4. Private treatment**: If financially viable, paying for private treatment can bypass NHS waits. However, this raises equity concerns and does not solve the systemic problem.

**5. Complaints and advocacy**: If you experience unreasonable delays or poor communication, raise concerns with the hospital's Patient Advice and Liaison Service (PALS) or the Parliamentary and Health Service Ombudsman.

## The international context

The UK is not alone in facing healthcare pressures, but NHS performance has deteriorated more sharply than comparable countries. **OECD data** from 2023 shows:

- **UK health spending** as a share of GDP (11.3%) is close to the OECD average (11.1%), but lower than Germany (12.8%), France (12.2%), and Sweden (11.4%)
- **Waiting times** for elective surgery are longer in the UK than in most Western European countries
- **Life expectancy** in the UK (81.3 years) has stagnated since 2010, while continuing to rise in France, Spain, and Italy
- **Avoidable mortality** (deaths from conditions that should be preventable or treatable) is higher in the UK than the EU average

The **Commonwealth Fund**, a US-based health policy foundation, ranked the UK **4th out of 11 high-income countries** in its 2021 health system performance comparison, praising equity and access but criticising outcomes and waiting times.

## The road ahead

The NHS waiting list crisis will not be resolved quickly. Even with additional funding and workforce growth, clearing the backlog while meeting new demand will take years. The **key challenges** are:

**1. Workforce**: Recruiting and retaining staff is the critical constraint. International recruitment helps, but the NHS must also improve retention by addressing pay, workload, and working conditions.

**2. Productivity**: The NHS must produce more activity from existing resources. This requires investment in digital systems, streamlined pathways, and reducing administrative burden on clinicians.

**3. Prevention**: Reducing demand through public health measures (obesity reduction, smoking cessation, early intervention for mental health) will take years to show results but is essential for long-term sustainability.

**4. Social care**: Delayed discharges due to lack of social care capacity block hospital beds. Fixing social care is inseparable from fixing the NHS.

**5. Political consensus**: The NHS requires sustained investment over decades. Short-term funding cycles and political point-scoring undermine long-term planning.

## The bottom line

NHS waiting lists in England reached 7.8 million patient pathways in September 2024, the highest on record, with over 400,000 patients waiting more than a year for treatment. Emergency department performance has deteriorated, with only 65% of patients seen within 4 hours against a 95% target. The crisis is driven by post-pandemic backlogs, chronic staff shortages (112,000 vacancies), industrial action, and rising demand from an ageing population. The NHS faces a projected £14 billion funding gap by 2030 without significant investment or reform.

The government has announced £8 billion in additional funding for elective recovery and committed to a 10-year NHS plan, but health experts warn that clearing the backlog will take years even with additional resources. Patients face difficult choices between waiting for NHS treatment, paying for private care, or living with untreated conditions. The waiting list crisis is not just a statistical problem—it represents millions of people in pain, unable to work, or facing deteriorating health while they wait. Solving it requires sustained political will, adequate funding, workforce investment, and productivity improvements across the health and social care system.

## Frequently asked questions

### Why are NHS waiting lists so high?

Multiple factors contribute to record waiting lists: the COVID-19 pandemic created a backlog of delayed treatments, with elective procedures suspended for months in 2020-2021; chronic staff shortages mean fewer clinicians are available to see patients; industrial action by junior doctors and consultants in 2023-2024 led to thousands of cancelled appointments; and rising demand from an ageing population with more complex health needs has outpaced capacity growth. NHS England estimates it will take until 2025-2026 to clear the backlog even with additional funding.

### What is the NHS doing to reduce waiting times?

NHS England has implemented several initiatives including: expanding community diagnostic centres to increase scanning and testing capacity; offering patients treatment at alternative hospitals with shorter waits; using independent sector capacity for routine procedures; implementing virtual wards to free up hospital beds; and recruiting internationally trained staff to fill vacancies. The government announced £8 billion in additional funding over two years in the 2024 Autumn Statement specifically to tackle waiting lists, though health economists argue this is insufficient to meet demand.

### How do I get treatment faster on the NHS?

Legitimate options include: asking your GP about the Patient Choice scheme, which allows you to choose any qualified provider including private hospitals contracted to the NHS; checking if you're eligible for faster treatment through clinical priority (urgent cases are seen first); considering treatment at a different NHS trust with shorter waits; and exploring NHS-funded community services for diagnostics. Avoid paying for private consultations solely to 'jump the queue' back into NHS treatment, as this doesn't typically reduce overall waiting times and raises equity concerns.

## Sources

- [NHS England — Referral to Treatment (RTT) Waiting Times Data](https://www.england.nhs.uk/statistics/statistical-work-areas/rtt-waiting-times/)
- [The King's Fund — NHS waiting lists: what you need to know](https://www.kingsfund.org.uk/)
- [Nuffield Trust — NHS performance summary](https://www.nuffieldtrust.org.uk/)
- [British Medical Association — NHS staffing crisis analysis](https://www.bma.org.uk/)

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