The number of people in England forced to wait more than 18 weeks for a non-urgent operation could more than double as a result of the NHS’s decision to relax the obligation on hospitals to treat 92% of them in that time, a leaked document has revealed.



The possibility of the backlog rising from 370,000 in February this year to around 800,000 by March 2019 is one of several scenarios sketched out in a presentation to hospital bosses by NHS Improvement, the service’s financial regulator.

Graphs in the document, obtained by the Health Service Journal, indicate that the proportion of patients being seen within 18 weeks could fall from the current 90% to about 85% and the total number of people waiting for planned hospital care for procedures such as hip and knee replacements and cataract removals rise sharply from just less than 4 million to almost 5.5 million. A “sustainable” waiting-list should have no more than 3 million people on it, it says.



“NHS Improvement’s waiting time estimates paint a devastating picture for patients and hammer home just how damaging deprioritising the 18-week target for planned surgery will potentially be. Without further help from the next government after the election, this is what the real impact will be on patients of successive underfunding of the NHS,” said Ian Eardley, vice-president of the Royal College of Surgeons.



NHS England chief executive Simon Stevens sparked controversy in March when he announced that the 92% target was being downgraded so that hospitals could concentrate on improving their performance against other targets covering A&E care and cancer treatment.



Meanwhile, the annual increases in the NHS budget since 2009 have been less than a third of the average yearly funding rise the health service has had over the past 60 years, according to the Institute for Fiscal Studies. Public spending on health across the UK went up by 1.3% a year between 2009-10, Labour’s last year in power, and 2015-16, the first year of David Cameron’s majority Conservative government.

The IFS said: “This is substantially below the average growth of 4.1% per year between 1955-56 and 2015-16. Spending growth under the coalition was the lowest five-year average since records began (though generous compared with the cuts to spending in other government departments over the same period).”

The years of small budget increases against the backdrop of a growing and ageing population mean that health spending per head will have fallen by 1.3% from 2009-10 to 2019-20. George Stoye, the IFS senior research economist who carried out the analysis, said the annual rises since 2009-10 were “the lowest rate of increase over any similar period since the mid-1950s, since when the long-run annual growth rate has been 4.1%”.

“Current government plans are consistent with David Cameron’s pledge at the 2015 election to increase NHS spending by £8bn. But they would leave health spending in 2019-20 below the amount needed simply to keep pace with the growth and ageing of the population seen since 2009-10, let alone the amount required to account for multiple other pressures on the health budget,” said Stoye.

The government’s policy of putting more cash into the NHS’s budget by shrinking Department of Health spending on public health and medical training is likely to backfire, Stoye said. A planned £3.4bn cut in such investment from 2015-16 to 2020-21 “may also have spillover effects on the NHS if public health deteriorates (and therefore more NHS services are required) or hospitals find it hard to recruit staff”.

A separate IFS briefing paper found that spending on adult social care fell by 8% in real terms, and by 13.5% per adult in England, between 2009-10 and 2015-16 because the population increased. The heaviest cuts were in the areas of greatest need, which were also the poorest parts of the country, the thinktank found.

Opposition parties seized on the findings to accuse the government of underfunding key public services. Labour’s Jonathan Ashworth said: “These IFS figures lay bare the total failure of the Tories to protect patient safety by properly investing in our health and social care services.

“It’s disgraceful that Theresa May has left health spending rising at its lowest rate since the mid-1950s, and her failure to implement wider social care reform demonstrates her ignorance of the serious challenges faced by carers across the country.”

Norman Lamb, the Liberal Democrat health spokesman, said: “[These figures] reveal the sheer scale of the crisis facing the NHS and social care in the years ahead. [Without] bold solutions ... we will see standards fall and hospitals collapse under the pressure of growing demand.”

Theresa May has so far refused to say during the general election campaign whether she plans to give the NHS more than the £8bn pledged by her predecessor.

The Conservatives did not challenge the accuracy of the IFS conclusions, but a spokesman said: “In truth, any increase in funding for the NHS – and we have committed to an extra £10bn by 2020 – is based both on a strong economy and securing a good Brexit deal.

“In this election, the public has a clear choice between the strong and stable leadership of Theresa May, growing the economy and investing record amounts in the NHS, or a weak and floundering Jeremy Corbyn, whose plans have a multibillion-pound black hole in them.”