The main NHS waiting list is likely to peak at around 8 million next summer before eventually starting to decline, according to a study.
Researchers at the Health Foundation think tank say strikes by doctors and consultants in training have hampered efforts to clear the Covid backlog.
The list currently stands at a record high of 7.75 million, which is 210,000 more than would have been the case without industrial action, they add.
In February 2020, 4.6 million people were waiting for treatment, but the numbers soared when the NHS postponed most routine care during the pandemic to prioritize Covid patients.
The new analysis indicates that Rishi Sunak and NHS England are unlikely to achieve their targets to reduce waiting times quickly.
The widening backlog in England stood at 7.75 million in August – the equivalent of one in seven people. This includes nearly 400,000 people stuck in the system for more than a year, often in pain
The policy experts examined four possible scenarios to look at the prospect of reducing the waiting list by the end of 2024.
On current trends, it could peak at 8 million in August 2024 if no further strike action takes place, before falling again.
If strikes over wages continue, the waiting list could be 180,000 higher at the same point next year.
The analysis suggests that strikes are also likely to have indirect impacts, putting pressure on NHS finances and diverting management attention from improving productivity.
NHS England’s elective care recovery plan, published in February 2022, included expectations that lists would fall by March 2024, while the Prime Minister promised in January 2023 that ‘NHS waiting lists will fall and people will get care faster’.
At the time the commitment was made, the waiting list was 7.2 million.
The analysis also includes illustrative better and worse scenarios.
Only in the better case, in which the number of completed treatments grows by 10.4 percent per year – a third faster than now – would the waiting list fall to the same level as when the Prime Minister made his promise at the end of 2024.
In none of the scenarios would the expectations from the recovery plan for elective care be met.
The number of monthly referrals for treatment is now back to pre-pandemic levels and growing faster, suggesting that patients who delayed seeking care after being told to ‘protect the NHS’ are now coming forward.
The number of monthly treatments is growing faster than before the pandemic, but the waiting list is still increasing because the number of treatments does not yet exceed the number of referrals.
The analysis shows that efforts to reduce the waiting list could also be disrupted by a new wave of Covid-19 or a bad winter flu season, or by cuts to hospital care due to financial pressure.
Charles Tallack, director of data analytics at the Health Foundation, said: ‘Behind these figures are people longing for a diagnosis, patients in avoidable pain and lives on hold.’
He said strikes, under-investment, staff shortages and the neglect of social care have all contributed to the rise, adding: ‘Clearing the elective care backlog and reducing waiting times to 18 weeks is entirely possible . can be done again.
“However, it will be a major challenge and require sustained focus, policy action and investment.”
Tim Mitchell, president of the Royal College of Surgeons of England, described the analysis as “sobering” and said more must be done to recruit and retain staff.
Saffron Cordery, deputy director of NHS Providers, which represents NHS trusts, said the findings showed the urgency of resolving strikes.
She added: ‘While strikes are not the main cause of longer waiting times, the report confirms that they make the problem worse by consuming NHS resources that could be better spent on reducing care backlogs.
‘Productivity and efficiency within the NHS are also taking a huge hit as the strikes impose unplanned costs.’
An NHS spokesperson said: ‘Thanks to the hard work of NHS staff, more patients are being treated than before the pandemic – 87,000 more in August than the same month in 2019.’
The findings come a day after a separate analysis by the Reform think tank suggested that 11 million patients are on ‘hidden’ NHS lists waiting for follow-up appointments after treatment.