Hospital bosses are bracing themselves for a clash with ministers over how quickly they can clear the backlog of NHS care that built up during the pandemic.

They are warning that it will take “years” to treat all those whose care was cancelled because Covid disrupted so many hospital services, particularly surgery and diagnostic tests.

Staff shortages, exhaustion among frontline personnel after tackling the pandemic and their need to have a break mean that progress will be slower than the government expects, NHS trust chiefs say.

“We can’t say with certainty how long it will take to tackle the backlog of planned operations because we don’t really know how big that backlog will end up being,” said Chris Hopson, the chief executive of NHS Providers.

“The NHS will obviously go as fast as it can, as we always do. But it’s already apparent that clearing the entire backlog will take years rather than months.”.

Over the last year, hundreds of thousands of people in England could not have an operation for cancer, heart disease or to have a new joint fitted or have a CT or MRI scan. One acute trust boss, who did not want to be named, said: “I think it will take many years. How long? Who knows?”

He added that hospitals are unlikely to be able to do more than slow the increase in size of the waiting list for care, which last week hit a record high of 4.59 million people.

Hopson warned that the situation would get worse before it got better. “It’s a real worry that, as a result of the pandemic, waiting lists have grown and will continue to grow for some time yet.”

Trusts also fear coming under political pressure to focus on the spiralling number of people who have already waited more than a year for a procedure. The total number of such cases shot up from just 1,613 in February 2020 to 304,044 by January this year, the latest official figures show.

“There will inevitably be pressure to prioritise those who have waited more than a year as the size of increase here is getting the most media and political attention,” added Hopson. MPs have already begun quizzing NHS England boss Sir Simon Stevens about when it will restart normal care.

However, hospitals need to be left to decide which patients are the most pressing priority and these will include those whose “priority two” operation – surgery which should be done within 28 days or delay could endanger health – was cancelled. “Sophisticated prioritisation” by doctors is better than “a simplistic approach that only focuses on those who have waited longest”, Hopson stressed.

Another trust chief executive, who also asked to remain anonymous, voiced unease that long delays could threaten the high esteem in which the public holds the NHS. “I’m concerned that public tolerance of the NHS is probably going to change as we come out of lockdown and access to appointments and services becomes more constrained.

“So there is a risk that the political imperative to restore at pace, to meet the demands of public opinion, comes into conflict with just how complex it will be for our staff to decompress,” they said.

The Department of Health and Social Care has been approached for comment.

This content first appear on the guardian

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