NHS waiting lists: how big is big?

Imagine a line with 1,000 at one end and 1 billion at the other end, where does 1 million go on the scale?

About half of people asked this question will put it in the middle, which makes sense in terms of the language of numbers, evenly spacing a thousand, a million and a billion. But this is a long way off in terms of its value. As the image below shows, 1 million actually comes just after 1,000.

While most of us know the language of numbers and could count ad infinitum, big numbers are in reality an abstract concept – very few of us will ever physically count a million objects. This abstract nature makes them notoriously difficult to conceptualise and understand.

Thankfully the waiting list for elective care in England doesn’t need to be counted in the billions, but as it hits the highest level since current recording began, do we really understand the difference between the currently 5.7 million people waiting and the potential 13 million people waiting that some have predicted. How can we think about those numbers in a way that makes them more meaningful and easier to understand?

One way is to convert them to time. Imagine, if one patient from the waiting list walks into an NHS hospital every minute of every day (24 hours a day), then it would take 11 years for them all to enter the building, or 25 years if the list reaches 13 million.

'While most of us know the language of numbers and could count ad infinitum, big numbers are in reality an abstract concept.'

Another option is to convert the number to more familiar units, for example, for every consultant-led bed in the NHS in England there is the equivalent of 40 people on the waiting list, or 92 people if the number reaches 13 million. Now this isn’t an entirely fair comparison because not every person on the waiting list will need to be admitted to hospital, for example many people waiting for cataract surgery can be treated as an outpatient, but it helps give some sense of the scale of demand versus the available resources. We can also think about it in terms of staff. The majority of people on the waiting list will have been referred by their GP, who will also continue to support them while they are waiting for treatment. For every full-time equivalent GP there are 157 patients on the waiting list, or 359 if it reaches 13 million.

Another way of comparing big numbers is to put them side by side with something of a recognisable scale. If we compare the elective care waiting list to countries, then the current 5.7 million figure is about the same as every person in Denmark being on the NHS waiting list. If the number grows to 13 million then we are looking at the equivalent of every person in Denmark plus every person in Scotland.

These conversions and comparisons are helpful for understanding what the waiting looks like as a snapshot, but we also need to remember the waiting list isn’t static. At the moment around 1.5 million people are joining the waiting list each month: sticking with the countries analogy, that’s half the population of Wales each month. The waiting list isn’t growing as fast as that because other patients are treated, but simple mathematics tells us that unless we treat more than half the population of Wales a month the list will keep getting bigger.

'In moving these numbers from the abstract to the meaningful we can engage people in the conversation... and, most importantly, remind them that we are talking about patients not just numbers.'

The waiting list for elective care is substantial and with all the pressures the health service is facing is going to be around for a long time. Those of us who talk about it should be thinking about how we play our part in explaining how big ‘big’ really is. And in moving these numbers from the abstract to the meaningful we can engage people in the conversation, enhance their understanding of what they really mean, and, most importantly, remind them that we are talking about patients not just numbers.