The must-read stories and debate in health policy and leadership.

The elective backlog in London is growing ever larger. Trusts are doing their best to eat into this swelling waiting list, starting with patients in most clinical need and those waiting longest. But with GPs referring more people into trusts, the lists are growing and showing no sign of stopping.

One trust in particular has had a bit of a rum time of it lately. The Royal Free London Foundation Trust, which treated thousands with covid over the past nine months, is seeing a sizeable number of north London residents referred into its services. On top of that, it is also dealing with a substantial pre-covid backlog.

It has been grappling with its elective waiting list. It stopped reporting against the referral to treatment 18-week standard in February 2019 because of data accuracy problems.

The trust then launched a massive data validation exercise. Its commissioners said a data validation exercise would examine 440,000 records. The trust in April 2020 finished validating those patients most likely to still need treatment, the commissioners said in a September board paper, adding that RFL was hoping to finish all the validation work by October.

Data seen by HSJ covering the elective waiting lists at London trusts as of 1 November shows the Royal Free has over 10,000 patients who have been waiting for treatment for between 40 and 52 weeks and a further 9,050 waiting a year or more.

Little room for manoeuvre

The impact of the second wave of covid has spread far beyond the areas with high rates of the disease. Cambridge University Hospitals Foundation Trust is in the East of England with some of the lowest covid rates in the country but it is still finding its day-to-day performance affected.

The trust reported 111 12-hour trolley waits in October – far beyond what it would normally see (it had one in the same month last year). The reason, says the trust, is that it has had to cut bed numbers by around 100 to reduce the risk of covid transmission. This has impacted on flow out of the emergency department, leaving staff struggling to find beds for all those who need to be admitted.

Other trusts are likely to be in similar straits – the number of 12-hour waits nationally was very high in October, looking more like a month in the depths of winter. HSJ has also reported on long ambulance waits at some hospitals, another sign of flow problems.

Trusts in this position really have little wriggle room: squeeze in more beds and they risk more cases of hospital-acquired covid. Yet it is becoming harder and harder to keep both A&E flowing and carry out electives at close to normal levels. As winter progresses, something will have to give.