NHS building
© NHS Trust
Up to 740,000 potential cancer cases that should have been urgently referred by GPs have been "missed" since the first lockdown, according to a damning report.

Watchdogs also warned that NHS waiting lists could keep growing until 2025 and even reach double the current six million.

Charities said the report by the National Audit Office (NAO) reflected a "devastating" situation for many patients, with medics warning of "the biggest cancer catastrophe ever to hit the NHS".

MPs said the situation was likely to get worse before it gets better, with millions of patients who should have been referred for care during the pandemic now missing from waiting lists.

Waiting lists could reach 12 million by March 2025

Latest figures show 5.9 million people waiting - around a 10th of the population.

The NAO estimates that between 7.6 million and 9.1 million fewer referrals for treatment were made during the pandemic, because of difficulties accessing care and fears of catching the virus.

It estimated that if 50 per cent of missing referrals returned to the NHS, and activity grew in line with pre-pandemic expectations, the waiting list would reach 12 million by March 2025.

A record number of people are waiting to start treatment on the NHS
Number of RTT patients waiting to start treatment by waiting time
wait list chart
© NHS England
The report expresses particular concern about a sharp fall in urgent referrals by GPs to hospitals, for cases of suspected cancer.

The NAO estimates a shortfall of between 240,000 and 740,000 missing referrals as a result of people struggling to get appointments with GPs, or keeping away from the NHS for fear of Covid or being a burden on services.

In turn, between 35,000 and 60,000 fewer people started treatment for cancer than would have been expected over the period.

The report warns of uncertainty about how many such patients will now seek help, amid warnings that, in many cases, disease may be more advanced and harder to treat.

Meg Hillier, chairman of the Public Accounts Committee, said:
"The pandemic has heaped yet more pressure on a care system that was already creaking under the strain. Covid-19 forced the NHS to cut back on normal activity, creating a backlog of patients who are now returning.

"The report estimates there are millions of 'missing' patients who avoided seeing or were unable to see a doctor during the pandemic. It's unclear how many will return or the impact this has had on their health. Things will get worse before they get better, with the NAO estimating that waiting lists will be even longer by 2025."
Recovery plan to tackle backlog of cases

It follows concern about difficulties accessing GP care during the pandemic, with a dramatic fall in the proportion of appointments taking place in person.

Before the first lockdown, around 80 per cent of appointments took place in person, a figure which fell to 47 per cent after the first lockdown. A recent increase has taken it to 64 per cent.

GP appointments by type
Appointments (million)
Blue red black line chart
© NHS DIGITAL
The NHS is preparing to launch its Elective Recovery Plan in an effort to tackle the backlog waiting for hospital care, as well as prioritise the most urgent cases. The plans could see patients able to book their own hospital appointments, check waiting times and travel further for care, if it means getting it sooner.

Health officials have said those on waiting lists should be able to contact hospitals directly, via the NHS app or phone. But millions of routine follow-up appointments are likely to be axed, in an attempt to prioritise those most in need.

Health officials have said such schemes would "give the power back to the patient" and mean doctors spend less time on "pointless" appointments which were not necessary.

Four in five people now on waiting lists are waiting for hospital appointments, rather than surgery. Officials say two in three of those waiting for outpatient consultations are "review" checks - which are routinely scheduled every six months for millions of people with long-term conditions, whether or not they are needed.

'Chronic staffing shortages are having a devastating impact'

However, charities are worried that insufficient attention has been paid to a growing crisis in cancer care, and shortages of staff.

Eve Byrne, head of campaigns and public affairs at Macmillan Cancer Support, said:
"This report confirms what we hear day in, day out from people living with cancer. Chronic staffing shortages are already having a devastating impact on cancer patients, and we have major concerns that are only set to worsen without urgent action.

"It could not be more vital that the Government's imminent Elective Recovery Plan for England includes a clear plan for getting people diagnosed with and treated for cancer. This needs to be backed up by steps to ensure we have enough nurses, so that the NHS is equipped to provide timely and quality care for all people with cancer - both now and in the future.

"Without these critical pieces of the puzzle, we risk increasing numbers of people facing later diagnoses, poorer care and potentially worse chances of survival."
Professor Pat Price, an oncologist and co-founder of CatchUpWithCancer, called for urgent action, warning that every month's delay in treatment could cut survival by a 10th.

He said the report
"shows we are in the middle of the biggest cancer catastrophe ever to hit the NHS. There is a deadly cocktail of delays across the board, a regional lottery of cancer inequality and a growing cancer backlog. And it feels like the Government and NHS leaders have their heads in the sand.

"We need the Government to urgently outline how additional funding will be spent on cancer treatments, backlog-busting technologies, like radiotherapy, and the cancer workforce. Cancer patients don't have the luxury of time, if we don't act more people will die who don't need to."
Dr Gary Howsam, vice-chairman of the Royal College of GPs, said:
"GPs take our responsibility to refer appropriately very seriously and we worked hard throughout the pandemic to continue to refer patients with possible symptoms of cancer in as timely a way as possible.

"There was a drop in urgent cancer referrals at the start of the pandemic, which evidence shows was mainly due to people following official guidance to stay at home, as well as concerns about catching Covid-19 and overburdening NHS services.

"Referral rates from March to the end of August this year exceeded pre-pandemic levels."
An NHS spokesperson said:
"Treating more than half a million patients in hospital for covid, as well as delivering a world-leading vaccination programme, has inevitably had an impact on some routine and non-urgent care, yet since the pandemic begun the NHS has performed millions of elective procedures and over 450,000 people have started treatment for cancer."