Students preparing for medical school interviews should have a good grasp of various hot topics that can be applied to their answers to demonstrate their awareness of current events.
The state of the NHS is always a very prominent topic in the news, in particular NHS waiting lists and the elective backlog, therefore it’s increasingly important to be aware of this for your upcoming medical school interviews.
In this handy guide, we will break down everything you need to know about the NHS Waiting List Crisis and Elective Care Backlog; including the current state of the NHS, what effect this is having on patients, the causes behind it and the use of private healthcare services.
We will also explain how to ace any medical school interview questions on NHS referral and treatment waiting lists.
Want to boost your revision and maximise your chances of receiving a UK medical school offer? Combine your reading here with medicine interview tutoring to enhance your answers and delivery.
NHS Wait Lists and Backlog Summary - What Do I Need To Know
NHS wait lists are longer than ever, with over 7.5 million people waiting for treatment in 2023
The largest patient backlog is for elective care services
Factors contributing to the increasing NHS waiting lists include underfunding, increased demand for NHS services, chronic workforce shortages, COVID-19 and the NHS worker strikes.
This backlog affects patients both mentally and physically, potentially leading to worsened patient outcomes
Private healthcare use has massively increased in recent years
In your interview, you should focus on showing that you understand the concepts you're talking about, rather than just memorising and repeating statistics. This article will help you gain that understanding.
👉🏻 Read more: Medicine Interview Questions Guide
In 2023, one in eight people are on an NHS waiting list in the UK. This equates to over 7.5 million people.
NHS Waiting Lists- What are they and who is on them?
The NHS Waiting List is a virtual queue of patients waiting for treatment from the NHS. NHS waiting lists are specific to the speciality that patients have been referred to.
A patient’s position on the waiting list will depend on their clinical priority, allocated by healthcare professionals.
This waiting list includes:
patients whose referrals have been made but not yet processed by a speciality.
patients waiting for an appointment after their referral to a specialty
patients who are waiting for their treatments to be started or arranged following an appointment
patients who have had appointments and procedures cancelled or delayed
The NHS Waiting Lists are split into elective and urgent lists.
Currently, the speciality with the largest NHS waiting list is trauma and orthopaedics. This will include elective patients waiting for surgery, such as hip replacements and knee replacements.
In 2023, one in eight people are on an NHS waiting list in the UK. This equates to over 7.5 million people.
Elective Care - What Is It?
This might be a question which medical school interviewers use to gauge your understanding of NHS waiting lists, so it’s really important that you understand what elective care is, and who these patients are.
Elective care describes treatment which is planned in advance, as opposed to emergency treatment. It includes operations, appointments or investigations which are not urgent or time-sensitive, therefore patients are entered onto a waiting list until the resources become available to complete the procedure.
The aim of elective care is usually to improve a patient's quality of life, such as in cataract surgery, and identify medical issues earlier to allow for early intervention. Early intervention at the first signs of illness is known to improve patient’s long-term outcomes.
One aspect of elective care is routine care, which is usually delivered in the primary care setting, such as in GP appointments. Routine care provided by the NHS is care which is regular and preventative.
Routine care includes screening for diseases, annual checkups, vaccinations and chronic disease follow-ups. It aims to prevent, identify and address illness early in order to improve patient outcomes.
👉🏻 Read more: 7 Tips to Ace Your Medical School Interview
Medicine Interview Question - What are some examples of elective care in the NHS?
Examples of elective care available within the NHS include:
Hip Replacements - improve patient’s quality of life through improved mobility and reduced pain and discomfort
Cataract Surgery - improve patient’s quality of life through improvement to visual impairment
Bariatric Surgery - helps patients struggling with obesity to lose weight, which may reduce other health burdens secondary to obesity.
NHS Urgent Care - What Is It?
Urgent Care in the NHS describes services which treat patients with acute health problems which are not life-threatening. These patients require care sooner than can be provided through routine or elective care, due to fear of deterioration or complications.
These include patients who present with serious infections, acute injuries, mental health crises and exacerbations of chronic conditions.
👉🏻 Read more: NHS Core Values
NHS Referral To Treatment Waiting Times: The Maximum Recommended Wait Times For Referrals
The Referral To Treatment (RTT) waiting time a patient experiences is the time taken between the receipt of a referral by the appropriate medical staff to the commencement of treatment or discharge if treatment is deemed unnecessary. This is the time that a patient is on an NHS waiting list.
For non-urgent treatment from a hospital consultant, the maximum recommended wait time is 18 weeks.
There are a few exceptions to this recommendation:
If the patient is recommended to make changes before the treatment in order to improve outcomes (e.g. smoking cessation, weight loss)
Rearranged appointments by the patient prolong the waiting time for treatment.
Treatment is deemed unnecessary by a medical professional
The NHS Constitution set expectations that no less than 92% of patients should meet this 18-week wait time.
For urgent treatment, the maximum wait time is 2 weeks. This is most notable in the suspected cancer “2-week wait” pathway.
👉🏻 Read more: NHS GP Shortage and Crisis
What has happened to NHS Waiting Lists and what is the NHS Backlog?
Fundamentally, NHS waiting lists and the patient backlog exist because the NHS’s capacity to provide treatment is less than the demand from the population. As waiting lists increase, the patient backlog increases.
Waiting lists are growing, with a record 7.5 million patients in the ‘backlog’, a number which is said to take “years” to clear.
The largest patient backlog exists in the elective care sector.
How has the backlog affected RTT waiting times?
The increasing patient backlog has led to waiting times increasing, particularly in low-urgency and low-priority areas, such as trauma and orthopaedics.
In 2023, only 58% of patients started treatment within 18 weeks of referral. This is significantly less than the 92% standard set by the NHS Consortium.
In 2023, only 78% of the 2-week wait pathway suspected cancer referrals were seen within 2 weeks. This is significantly less than the 93% standard set by the NHS Consortium.
In addition, only 61% of patients started a first treatment for cancer within the target of 2 months. This is less than the 85% target.
👉🏻 Read more: The New NHS Long-Term Workforce Plan Summary
Cancer Care Rule Changes - No More Two Week Wait (2WW) Pathway
The NHS changed its rules on how quickly cancer patients should be seen, diagnosed, and treated, starting October 1st 2023. This is to make the system less confusing for patients and focus on what matters most - getting people treated faster.
Previously there were 10 different waiting time rules the NHS must follow - this was very complex to manage!
The main changes were:
Scrapping the 2-week wait standard. This old standard stated patients with suspected cancer must see a specialist within 2 weeks of being referred by their GP. But now we have faster ways to diagnose cancer without needing in-person appointments first.
Instead, the focus is on a new 28-day Faster Diagnosis Standard - patients should get a cancer diagnosis or all-clear within 28 days from their first appointment. This looks at the full journey from first concerns to diagnosis.
For treatment, there will be one simplified 62-day standard from referral to starting treatment, instead of multiple targets for different cancers. The aim is to treat 85% of patients within 62 days.
Once diagnosed, 96% of patients should begin treatment within 31 days. This ensures treatment is started quickly.
This should improve outcomes for patients. As a future doctor, understanding NHS cancer waiting time targets will be useful for your medical school interviews when asked about the NHS.
The NHS Backlog: What are the contributing factors?
In your UK Medical School Interviews, you might be asked: why are the NHS Waiting Lists so long? You should make it clear in your answer that there are a number of factors which led to the NHS backlog developing, and why it will take years to be cleared.
Overstretched service
Pre-pandemic, NHS waiting lists were already increasing, attributable to years of mounting pressures on an overstretched and under-resourced system. With decreasing NHS bed numbers, insufficient funding, outdated technology, and building maintenance backlogs, the NHS faces an ever-exceeding demand, with a decreasing capacity.
This exceeding demand for healthcare services stems from the ageing population of the UK, with more patients requiring specialist treatment for their complex needs.
👉🏻 Read more: Ageing Population in the NHS
Chronic workforce shortages
Although the NHS workforce is increasing in size, this is inadequate for the demand and service provision required. Vacancy rates are high, and many posts are filled by expensive bank and agency staff.
The workforce crisis is argued to be a retention problem, with staff leaving for a better work-life balance or as a result of health issues. Decreasing NHS staff satisfaction may have a role to play in this, owed to pay cuts and worsening working conditions.
👉🏻 Read more: Junior Doctor Contract and Controversies
The impact of COVID-19 and the pandemic
In response to the COVID-19 pandemic, there was a strategic redirection of staff and cancellation of elective and routine care. This allowed prioritisation of patients of higher medical concern and reduced infection spread from unessential or time-limited contact. This caused NHS wait lists to increase massively.
Additionally, since the pandemic, some parts of the NHS haven’t returned to full capacity. For instance, there remains to be decreased elective care activity, which may contribute towards the increasing backlog.
NHS Strikes
NHS Strikes are the primary concern named by Prime Minister, Rishi Sunak, for the increasing NHS backlog. The direct effect of NHS worker strikes includes operation and outpatient appointment rescheduling, with data showing that Junior Doctor’s 2023 strikes had a greater impact than those of nurses or ambulance workers.
Many refute the Prime Minister’s claim, arguing that the strike impact is minimal relative to the size of the existing NHS waiting lists.
👉🏻 Need to refresh your memory of the NHS strikes? Read more here: Junior Doctor Contract and Controversies and BMA Junior Doctors’ Strikes in the UK.
What is the NHS hidden backlog?
The NHS Hidden Backlog forms the unknown proportion of patients who haven’t presented to their GP for referral, perhaps due to fear of putting strain on services, or due to the pandemic.
The scale of this burden is unknown, and patients in this category tend to present with later-stage, more aggressive disease, which would have benefited from earlier presentation and assessment for treatment.
How is the NHS backlog affecting patients?
It is well documented that the long delays for treatment have a significant impact on patients from both a physical and mental health perspective.
Worsened Condition: The longer a patient stays on an NHS waitlist, the greater the risk of their condition deteriorating. This will cause further suffering for the patient, and increase the complexity and cost of treatment required.
Delayed Diagnosis: Increased waiting times for diagnostic testing causes a delay in the patient being diagnosed. For some disease processes, this means that early intervention treatments may have been missed, and the patient’s prognosis can worsen.
Stress: Waiting for diagnosis or treatment can cause increased levels of stress and anxiety for the patient. If the patient is unable to work during this time, there may be an added financial burden.
Reduced Quality of Life: For elective surgeries in particular, patients may suffer from decreased quality of life in the time waiting for their treatment, such as from pain or discomfort.
An increasingly common internet search is “How to jump the NHS waiting list”, as patients are desperate to receive treatment. Some patients transfer to different hospitals with shorter waiting lists in order to benefit from sooner treatment availability.
Others seek expensive private healthcare in order to access faster referrals and treatment.
👉🏻 Read more: NHS Core Values
Private Medicine: How have NHS waiting lists affected private practice?
As NHS waiting lists have increased, so have the number of UK private healthcare admissions. This is most prominent for elective surgeries, such as hip replacement surgery, where patients are paying large fees to cover the cost of procedures usually covered on the NHS.
Likewise, the number of UK residents travelling abroad for medical treatment has increased massively - a concept known as “outward medical tourism”.
These both point to the desperation of UK residents for timely medical treatment. It further widens the health inequality between different socioeconomic groups - those who can afford to ‘skip the queue’, and those who cannot.
👉🏻 Read more about NHS Privatisation
How is the government planning on handling the NHS Backlog?
The government have created an Elective Recovery Plan, which details:
Further NHS funding
Increased workforce recruitment - find out more about the 2023 NHS Workforce Plan
Increased resources - including surgical hubs, community diagnostic centres and improved technology.
👉🏻 Read more: The New NHS Long-Term Workforce Plan Summary
How to answer an interview question on waiting lists and the NHS backlog
NHS Waiting lists are a large and controversial topic within the healthcare news. In light of the NHS worker’s strikes, the NHS backlog is often used as an argument against industrial action.
This makes it a relevant topic for your UK Medical School Interviewers to ask you about.
When answering an interview question on NHS waiting lists, there are a number of topics you could try to address:
Patient Frustration and NHS Reality - NHS waiting lists are an unfortunate reality that doctors and healthcare staff have to face. Patients may be angry, frustrated and feel let down from having waited so long for appointments. You must be able to show empathy for these patients,
Physical and Mental Impact of Waiting Lists - you need to express your understanding of the toll that waiting lists can have on patients. Again, it’s vital that you show compassion when talking about patients, the adverse outcomes from NHS Waiting Lists and the effects of the NHS backlog.
The NHS Backlog cannot be attributed to a single cause - you should demonstrate your understanding of the platitude of reasons behind the NHS Backlog, and how these have all compacted to create the current crisis.
There is no simple solution - given the multifactorial cause for the Backlog, there is no single change which can significantly reduce the waiting lists. Government initiatives have been made to combat this, but have been unsuccessful at meeting their targets.
👉🏻 Read more: Medicine Interview Questions Guide
More NHS Waiting Lists Medicine Interview Question Examples:
Explain what the NHS waiting lists are, and why they exist
What is the difference between elective and urgent care in the context of NHS services?
What are the maximum recommended wait times for NHS referrals, and why are these timeframes important?
Could you elaborate on the concept of the "NHS backlog"? Why has it become a significant issue?
What factors have contributed to the development of the NHS backlog, and why is it expected to take years to clear?
How has the COVID-19 pandemic impacted NHS waiting lists and the backlog?
What is the hidden backlog in the NHS, and why is it a concern?
What effects do long delays in NHS treatment have on patients, both physically and mentally?
Why do some patients seek private healthcare or transfer to hospitals with shorter waiting lists, and what ethical considerations might arise from this trend?
What steps can be taken to address the NHS waiting list crisis and reduce the backlog?
👉🏻 Read more: 280 Medical School Practice Interview Questions
NHS Waiting Lists FAQ
Why are NHS waiting times a concern for patient health?
Prolonged NHS waiting times can cause patients' conditions to deteriorate, leading to more intricate treatments. Such delays can increase stress, and anxiety, and impact overall well-being.
How are patients prioritised on the NHS waiting list?
Patients are ranked based on clinical urgency. Those with the most pressing needs are attended to first. Factors influencing this include the severity of the condition, potential complications, and the effect on daily life.
What consequences arise from extended NHS waiting times?
Extended waits can intensify health conditions, sometimes leading to complications. This strains not just the patient's quality of life, but also the NHS resources.
How can the NHS reduce waiting times?
Reducing waiting times involves augmenting healthcare infrastructure, embracing technologies like telemedicine, recruiting more healthcare professionals, and refining the referral system.
In addressing the waiting list backlog, how does the NHS allocate resources?
Resource allocation targets the clinically driven needs of the waiting list, factoring in the number of waiting patients, the severity of their conditions, and available resources.
How is technology assisting in managing NHS waiting times?
Technological advancements, especially telemedicine, offer remote consultations, minimizing hospital visits. Additionally, data analytics helps streamline resource allocation.
What role do GPs play in the NHS system?
GPs are pivotal, in evaluating patient symptoms and directing them to the relevant specialists. However, limited specialist availability can prolong waiting times.
What policy measures could address the NHS waiting list challenge?
Key policies could involve increased healthcare funding, strategies for attracting and retaining medical staff, infrastructural investments, and the integration of innovative technologies.
How is the UK operation backlog affecting patients?
The operation backlog in the UK results in delayed treatments, heightening potential health risks, mental distress, and further financial demands on the NHS.
Why is there a surge in NHS waiting times?
Various factors, including funding shortages, staff limitations, and increased patient influx, contribute to the rise in waiting times.
How can patients manage extended waiting times?
While waiting, patients can seek advice from GPs, explore telehealth options, or consider private healthcare if feasible.
What is the government's stance on the waiting list issue?
The government acknowledges the challenge and is exploring measures like funding boosts and policy reforms to alleviate the situation.
How does the waiting list backlog compare to previous years?
Recent years have seen a notable increase in the backlog, largely attributed to factors like population growth, ageing demographics, and budgetary constraints.
Are there alternative healthcare options while waiting?
Patients can explore private healthcare, seek advice on interim treatments, or consider telehealth consultations.
What's the expected future trend for NHS waiting times?
While efforts are underway to address the backlog, demographic changes and financial constraints suggest that waiting times might remain a challenge.
Is telemedicine a permanent solution for the NHS backlog?
While telemedicine alleviates some pressure, it's part of a broader solution set that includes increased funding, infrastructural upgrades, and staff augmentation.
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