Backlog Britain: How public sector delays spiralled to record levels
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Britain’s public services are afflicted by chronic backlogs across a broad range of areas, including hospitals, courts, mental health, asylum and social security claims, according to data collated by the Financial Times.
The pernicious combination of the Covid-19 pandemic straining public services and the legacy of a decade of austerity cuts imposed after the 2008 financial crisis, are to blame for the upsurge in waiting times, experts said.
They also warned of a bleak outlook for reducing the backlog as public services brace for widespread industrial action this winter, along with rising demand due to the cost of living crisis and future budget squeezes announced in Autumn Statement this month.
In the NHS, where nurses voted to go on strike next month over pay, more than 7mn people are waiting for non-urgent, or elective, treatment. At the same time, key standards for cancer care and A&E waiting times are being missed by record margins.
Despite the government setting out a blueprint to tackle elective waiting lists last February, health specialists warned the NHS was trying to address this with a brutally attenuated workforce and fewer beds than many comparable OECD countries.
Around 10 per cent of NHS posts are vacant and data published this month showed that acute hospital beds are already 95 per cent full, an occupancy level generally associated with the depths of winter, rather than an unseasonably mild November.
Sally Warren, director of policy at the King’s Fund think-tank, said that the health system was so stretched on all fronts, it was hard to arrest the deterioration in performance.
“Once you’re running at more than 90 per cent capacity, you really don’t have much space to go . . A problem that might have been isolated to one part of the system now feels like it’s impacting right across [it],” she said.
The social care system, which should in theory be relieving pressure on hospitals by treating more elderly people in the community, is facing its own crisis, with vacancies running at similar levels to the NHS.
The pandemic, as well as creating a backlog of clinical cases, has exacerbated a surge in mental health problems over the past decade, particularly among children, which has not been matched by a commensurate increase in capacity in mental health services.
According to a major study by the Sutton Trust, a charity, this week, 44 per cent of teenagers around 16 years old met the threshold for high psychological distress this year, up from 35 per cent in 2017 and 23 per cent in 2007.
Steve Crocker, president of the Association of Directors of Children’s Services, which represents senior managers working in the sector in local government, said the failure to provide early interventions for families was creating a vicious circle, leading to families needing greater interventions, piling pressure on the system.
“Increasingly in children’s social care we are seeing children that should have been seen by mental health services a long time previously, but weren’t,” he said.
As cost-of-living pressures start to bite, claims for disability benefits are running at their highest level on record, with the Department for Work and Pensions struggling to process a backlog of hundreds of thousands.
The latest figures, for the three months to July 2022, show new claimants waited around four months before receiving support — an improvement on even longer delays seen at the height of the pandemic, but enough to leave many in desperate straits.
“Our advisers see, day in, day out, the enormous strain people are under as they wait for money they are entitled to,” said Morgan Wild, head of policy at Citizens Advice. The charity has been referring record numbers of disabled people to food banks as they struggle to access personal independence payments, worth up to £157 a week for those with mental or physical disabilities.
The government received a record 180,000 new PIP claims in the three months to July, while managing decisions on 190,000 claims — which meant that more than 300,000 people were still waiting for a decision.
The DWP said that cutting waiting times was a priority, and that it was conducting more assessments by phone and video to speed up the process. But Citizens Advice calculates that if claims continue on their rising trend the backlog will fall only briefly before growing again in 2023.
Meanwhile, the UK’s family court system is chronically backed up, impacting adoption and care decisions, which Carol Homden, chief executive of children’s charity Coram, said this was in turn loading further pressure on struggling mental health and family support services.
A rise in private law cases — disputes between estranged parents over child contact — has led to a rising backlog in family courts. During the pandemic judges often chose to prioritise public law cases, which usually involve local councils taking children into care.
The delays have been blamed on a combination of high numbers of adjournments, as the courts grappled with remote court hearings during the Covid crisis, and cuts to legal aid, which has increased the number of people representing themselves, who require more time and support.
In the criminal courts, the case backlog had risen to more than 62,000 by the end of September 2022 — an increase of more than 20,000 since March 2020. The number of prisoners being held on remand — 14,507 as of 30 September 2022 — is the highest figure in 50 years.
A shortage of judges plus a wave of strikes by criminal advocates over pay has deepened the backlog. The Bar Council reported this month that the number of barristers working full-time on criminal legal aid cases had dropped by 15 per cent since 2018-19.
The government has said it wants to reduce the crown court waiting list to 53,000 by March 2025, opening temporary so-called “Nightingale” courts to hear cases, raising the judicial retirement age and giving magistrates powers to impose maximum prison sentences of a year rather than six months.
However, Lord Ian Burnett, the Lord Chief Justice of England and Wales, told MPs at the Commons justice committee in November that the 53,000 target was now in doubt as it “will require a reduction which I think is going to be very difficult” given that the numbers of complex cases “has increased disproportionately”.
The UK’s asylum system is also visibly creaking, with the number of those waiting for claims to be processed rising by more than 110,000 since 2018, with a record 143,377 claimants awaiting decisions by September this year.
This increase can only be partially explained by a rise in applications. While requests hit 72,027 in the year ending September 2022 — twice the number at the peak of the European migration crisis in 2016 — the backlog has risen fourfold in the same time.
This has left tens of thousands of asylum seekers stuck in temporary accommodation with hotel bills alone costing the government more than £6mn a day.
In a July report, the House of Commons Home Affairs Select Committee blamed “antiquated IT systems, high staff turnover, and too few staff” for slow processing rates. The monthly decision-making rate of Home Office caseworkers has slowed by nearly two-thirds in the decade to 2022, according to data analysis by the Institute for Government think-tank.
Home secretary Suella Braverman has acknowledged that the system is “broken”, telling MPs last week she was streamlining the process and aiming to recruit 500 case workers by March, bringing the total to around 1,300. “I agree the backlog is too high,” she said.
FT Reporters: Peter Foster, Federica Cocco, Oliver Hawkins, Sarah Neville, Delphine Strauss, Bethan Staton, Jane Croft and William Wallis
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