BACKGROUND: In April 2020, Covid-19 brought NHS elective procedures to a halt . The aim of this paper is to produce accurate forecasts on the building backlog, highlight the state of waiting lists currently and propose solutions required to prevent a public health crisis .
METHOD: Using data published by NHS digital and NHS England on previous years, we have analysed and used this to produce estimates of cancellations and missed cases . We also analyse government data on waiting lists and show compliance or lack of with these .
RESULTS: We show that compliance with waiting list times pre pandemic was falling year on year (83.2% in 2020 down from 87% in 2019). Every month that passes we estimate that 400 000 cases are not being performed . This may include urgent cancer care work in some trusts .
CONCLUSIONS: Waiting lists have been governed by strict rules since 2004 . Given falling compliance with 18-week intention to treat we believe the scale of the backlog combined with NHS capacity diminished due to Covid-19 precautions is a public health crisis waiting to occur . We identify difficulties in resuming elective work and suggest strategies that could be employed to avoid a public health crisis.