ENT Waiting Lists

15 March 2024

Waiting lists across the NHS remain high; however, they are particularly long for ENT services and have been increasing for over 10 years.  The reasons for this increase are complex but include major changes in both primary care, secondary care, and workforce challenges within the specialty. 

The biggest challenge is from primary care ENT referrals, especially uncomplicated and mostly non-surgical problems such as ear wax, simple ear infections, hearing loss, tinnitus and nasal allergy.  About 50% of referrals fall into this category.

Undoubtedly, the pandemic had a significant effect.  In 2013, the outpatient waiting list was about 200,000 and by 2019 it was 300,000. Essentially, no routine work was done for over a year, and by 2022 the list doubled to 600,000. 

Not surprisingly, the ENT operating waiting list also increased and currently, stands almost at 70,000, with 40% consisting of children and young adults, mostly waiting for tonsillectomy.  3,000 are waiting more than a year for surgery.

In April 2023, the Specialty Advisory Committee (SAC) in ENT reported on a detailed analysis of the ENT workforce and challenges affecting the specialty. This flagged a concerning number of non-substantive or unfilled Consultant posts, adding another significant challenge to patient throughput.

The issues are complex and not easily addressed.  ENT UK has been engaging with NHS England and Getting It Right First Time (GIRFT), looking at strategies to assist Trusts to control and reduce waiting lists.  There are examples of improved performance around the country and the Further Faster initiative from GIRFT has achieved significant reductions in waiting times. However, this will demand sustained effort and elective recovery will inevitably take a long time.

It has been estimated that to correct the global waiting list problems, the NHS would have to double the number of clinics and operating lists done every week for a year just to get back to 2019 levels.  This is an unrealistic goal from current resources, including staff, facility or finance, but gives some perspective to the size of the problem.  

Many hospital Trusts are already doing extra ENT lists and clinics during weekends and evenings, but with most NHS staff working to their absolute limit, there is little appetite or opportunity to do more without a substantial increase in resources.