The number of people waiting for hospital care in England could double to more than 8 million within a few months as a result of the coronavirus crisis, a leading health expert has warned. Measures that hospitals will have to put in place to tackle the infection as they seek to get back to normal after the pandemic would limit the number of patients who could have a planned operation, said Nigel Edwards, chief executive of the Nuffield Trust thinktank. “Given that we are also seeing hospitals having to take beds out to make space, they’ve got staff who can’t work on frontline duties and we haven’t got the testing or PPE [personal protective equipment] really in place to restart elective work as quickly perhaps as one might like, we’ve probably got another couple of months of that restricted activity [over planned operations],” Edwards told a hearing of the Commons health and social care select committee. “It’s hard to do the mathematics of this but it seems very likely that we’ll have doubled the waiting list to over 8 million by the late autumn, I would have thought.” The waiting list in England for people due to have non-urgent care, such as a cataract removal or hip or knee replacement, stood at 4.24 million in March. Edwards also warned that A&E units would not be able to safely go back to having large numbers of people in them and would struggle to enforce social distancing. “Most hospitals I know and have looked at do not have the physical space to do social distancing in their EDs [emergency departments], when we return to anything like normal levels of work,” he said. The NHS may need to insist that patients can only come to A&E if they have been referred there by a GP or the 111 telephone advice service, as happens in some countries, such as the Netherlands. His warning came as doctors voiced fears of “a ticking timebomb” of untreated illness because of coronavirus fears after the latest figures showed the lowest number of people in at least a decade sought A&E care in April. Just 916,581 people in England attended any kind of A&E unit last month. That was the fewest since records began in 2010 and is 57% down on the April 2019 figure. The number of people admitted to hospital in April as an emergency after attending A&E was also the lowest ever, at 326,581 – 39% down on the 535,236 admitted in April 2019. The figures have fuelled concerns that many thousands of people with potentially life-threatening ailments such as a heart or asthma attack, stroke or sepsis failed to seek care. “The sustained drop in A&E attendances is a significant concern given that many of those who have put off coming to hospitals as long as they possibly could during the first wave will be seeking treatment and could potentially be in worse conditions,” said Dr Nick Scriven, the immediate past president of the Society for Acute Medicine, which represents many hospital specialists. “This is a ticking timebomb in itself and it will be exacerbated by a myriad of other pressures in the coming weeks as hospitals adapt to running parallel units for infected or possibly infected acute work alongside elective work.” Potentially large but still unknown numbers of patients are also thought to have not sought help at A&E for delirium, broken bones and a worsening of their already serious breathing problems. While some of those who did not attend A&E may have got care elsewhere, such as at a GP surgery or pharmacy, the 39% year-on-year fall in emergency admissions to hospital has prompted serious concern in the NHS about people suffering serious consequences from untreated illness. “The fall in emergency admissions means there are loads and loads of people that are staying away from A&E who really ought to come in. That’s a real worry,” said one NHS source. “They are likely to be people with strokes, heart attacks, sepsis, delirium, severe asthma attacks, broken bones and exacerbations of chronic obstructive pulmonary disease.” Tim Gardner, a senior fellow at the Health Foundation thinktank said: “Today’s figures show coronavirus is having a seismic impact on how people are using the NHS. “This unprecedented shift in the way people are using health services, while it does ease the immediate pressures on the NHS, is a major concern and could mean that potentially urgent health problems are going undiagnosed or chronic problems are getting worse.” Another leading health expert warned that the NHS would struggle to get back to normal activity levels after the pandemic ended because it would face a huge backlog of care for patients whose treatment was not given because many services were suspended. “The NHS will find it very difficult to catch up. It will take many months and increased use of the independent sector to meet this unmet need and bring services back to the level we were seeing pre- Covid-19. The health service is going to have to adjust, and this will take time. That means more people waiting and some services on hold,” said Prof John Appleby, director of research and chief economist at the Nuffield Trust. There is no official explanation for such dramatic falls. But NHS England chiefs believe widespread fear of going to hospital and catching coronavirus, and a desire not to add to pressures on the health service are mostly to blame. The government has become so concerned by the likely scale of hidden illness, injury and death that it recently launched a campaign urging people to seek NHS care in the normal way despite hospitals’ focus on the disease.