WHEN, and how, will NHS elective activity ever recover to where it was before the pandemic?

As so often during the past three years, patients on waiting lists for “routine” surgery are the first casualties in efforts to free up capacity.

Three health boards - Borders, Ayrshire and Arran, and Greater Glasgow and Clyde - have paused all non-urgent planned operations.

READ MORE: How will Covid affect the NHS this winter? 

Elective orthopaedic work had already been temporarily suspended by several boards in December in anticipation of winter pressures.

The First Minister said she expected the latest pauses to last “for as short a period as possible”, but that will be small comfort for patients in pain who have had procedures postponed multiple times already.

HeraldScotland: The amount of elective activity scheduled by NHS Scotland has increased slowly since the middle of 2022The amount of elective activity scheduled by NHS Scotland has increased slowly since the middle of 2022 (Image: PHS)

By September last year, there were 142,000 people on inpatient and day case waiting lists compared to around 80,000 in 2019, and yet the number of elective operations being carried out on the NHS as ofNovember remained around 13% lower than pre-Covid levels.

Activity is increasing, but slowly. Successive waves of Omicron during 2022 saw elective activity repeatedly paused by several boards.

In September, routine Covid testing of asymptomatic NHS staff and patients.

READ MORE: Excess deaths are among the highest in 50 years - so how much is down to A&E delays? 

It was gamble partly aimed at increasing bed availability while accepting a higher risk of virus spread in healthcare settings.

As of mid-December, over 300 hospital patients a week were testing positive who had probably or definitely become infected in hospital - the highest since July, but lower than the peak of around 475 at the end of March last year.

HeraldScotland: Probable and definite hospital-onset Covid infections over time. Since the end of September, patient testing has been mainly limited to those showing possible symptoms so asymptomatic cases will no longer be countedProbable and definite hospital-onset Covid infections over time. Since the end of September, patient testing has been mainly limited to those showing possible symptoms so asymptomatic cases will no longer be counted (Image: PHS)

A steep resurgence in patients with influenza (who also require isolation) has complicated matters, however, with 1000 flu admissions a week in late December.

Some scientists argue that we will never really get on top of Covid and other airborne viruses in terms of their disruption to healthcare unless we pursue a much more vigorous approach to indoor ventilation and air cleaning technology, drawing comparisons with breakthroughs in water sanitation in the 19th century.

Eliminating delayed discharge would free up around 14% of NHS beds for elective admissions - but in the near future the best we can hope for is to reduce it.

READ MORE: The 'life-saving' service keeping hundreds of infection patients out of hospital 

A short-term option could be to increase the number of NHS patients sent private hospitals for treatment.

Surprisingly, given UK-wide backlogs, some independent providers report that they are receiving fewer NHS referrals now than before the pandemic - while the number of patients funding their own operations has soared.

Elective activity in 2022/23 was supposed to exceed pre-pandemic averages by 10%. That is a target now unlikely to be met for years.