The Primer provides a rapid guide to the most interesting comment and analysis on the English health and care sector that has not (usually) appeared in HSJ.

The gloomiest optimism

Issuing dire predictions about the size of the NHS waiting list (currently at 5.3 million patients) for coming years is becoming a regular sport, with experts eager to give their twopence after consulting crystal balls.

The latest outfit to grab the headlines with grim forecasts is the Institute for Fiscal Studies, which has examined new health and social care secretary Sajid Javid’s warning that the waiting list could rise to 13 million patients. Its conclusion is spread out over four possible scenarios, none of which can be said to be anything other than a disaster for patients.

One of the four forecasts the list growing from 5.3 million currently to 14 million by autumn 2022 and further after that. This is based on around 80 per cent of the 7 million “missing patients” (who did not come forward for care during the pandemic) returning in the next 12 months and the NHS operating at 90 per cent of its 2019 capacity.

By tweaking the numbers of patients coming forward and the NHS’ elective capacity, the IFS suggests three other alternative scenarios – two of which see the waiting list ballooning to either 8.6 million or 15 million by 2025. The final scenario, which the IFS despondently describes as its “most optimistic”, sees the list rise to more than 9 million patients next year, and only return to pre-pandemic levels by 2025. Doesn’t sound so bad? Well, the IFS says that will only happen if the NHS can increase its capacity to 5 per cent more than 2019 in 2021 and 2022, and by 10 per cent of the 2019 baseline in 2023 and onward – which is the equivalent of treating 1.6 million extra patients annually compared to 2019 at the potential cost of at least £2bn.

Let’s hope the IFS’ modelling holds a similar fate to those which in summer 2020 forecast a rise to 10 million patients by Christmas 2020 — a prediction attributed at the time to the NHS Confederation, and which it cited, but which it the Confed points out was in fact carried out by others.

Off the podium

In 2017, NHS England proudly published a press release highlighting a report from the Commonwealth Fund which ranked the health service best of 11 international healthcare systems. But alas, in the same week as Team GB’s Olympic athletes were ramping up their medals’ tally, the NHS was bumped down to fourth in the US thinktank’s latest assessment.

It is the third such report by the Commonwealth Fund, which also placed the NHS top in its inaugural ranking back in 2014. Now, the NHS has been surpassed by Norway, Netherlands and Australia. The reasons for the NHS’ drop are its performance against three of five domains: Access to care, the co-ordination of treatment/involvement of patients, and the ability for patients to obtain care regardless of income.

The fourth-placed finish has not merited a press release from NHS England (which declined to comment to the Guardian), but the report’s findings “can’t be brushed under the carpet” according to the King’s Fund’s analyst Siva Anandaciva. He said: “While the NHS is doing its best to keep services running, increasing demand for hospital, mental health and GP services means the whole health and care system is now facing a capacity crunch”.

Sunak vs Sajid

August always marks the start of what journalists call “silly season”, with parliament’s summer break inevitably causing news pages to be increasingly filled with rumours and briefings masquerading as exclusive stories. According to the Sunday Times, the NHS could have been reporting to Rishi Sunak instead of Sajid Javid after Boris Johnson briefly entertained the idea of demoting the Chancellor to Victoria Street after a staged leak of his opposition to the UK’s travel rules last week.

But instead, the NHS is set for a role as the rope in a tug of war between Mr Sunak and Mr Javid (according to the Observer), with the former chancellor eager to avoid being scapegoated for letting the IFS’ predictions on spiralling waiting lists come to fruition. 

The Chancellor is also urged by NHS Providers CEO Chris Hopson to accept the argument that the NHS needs more investment beyond the five-year settlement (an extra 3.3 per cent of revenue funding) announced by Theresa May back in 2018. In his op-ed in the Observer, Mr Hopson says the goalposts have changed significantly since the settlement, and that more funding will be needed for the health service to be able to meet the government’s manifesto commitments.

Expect plenty more like this in the next few months ahead of the much-anticipated spending review.

Updated on 9 August to clarify who forecast the waiting list could reach 10 million by Christmas 2020.