Patients could be waiting as much as two years for vital operations by the time of the next election due to a “truly frightening” backlog of care caused by the pandemic, the NHS’s former boss has said. Lengthening delays in getting treatment in England are will become a major political problem for Boris Johnson and pose a risk to patients’ health, Sir David Nicholson told the Guardian. “The backlog is truly frightening. We can very easily get to the next election with people waiting over two years. It’s easy to do that,” said Nicholson, citing an explosion in the number of people waiting at least a year since the start of the Covid-19 crisis. “The whole issue of access [to care] is a greater threat to the NHS than privatisation because poor access undermines confidence amongst those people who fund the service – taxpayers,” he added. Nicholson was the boss of the health service from 2006 until 2014, when Simon Stevens took over. He is the chair of the Worcestershire acute hospitals NHS trust, is about to take up the same post at the Sandwell and West Birmingham hospital trust, and is also the chair of the NHS integrated care system in Herefordshire and Worcestershire, which brings together different providers of care. The widespread suspension of normal NHS diagnostic tests and surgery during the pandemic as hospitals prioritised Covid care has left the service in England with a record 4.59 million people waiting for hospital treatment. That number is set to rise to what the NHS Confederation believes could be as much as 6.9m cases by the end of the year as people on a “hidden waiting list” – who put off seeking help after discovering symptoms of illness – finally visit a GP. According to the most recent figures, the number of people who have been waiting for at least a year has rocketed from 1,613 before the pandemic struck to 304,044. Under the NHS Constitution, 92% of people waiting are meant to be treated within 18 weeks. However, a third of the 4.59 million people have already waited longer than that. In an interview, Nicholson also said the NHS struggling for the first time in its history to give people who doctors have said need urgent cancer or heart surgery their procedure within 28 days. These “priority two” or “P2” patients are at risk of their health worsening – for example, their cancer becoming inoperable – unless they are operated on in that timeframe. Many thousands of P2 operations were postponed during the Covid second wave this winter. “Even the waiting list problems that I dealt with in my career, we’ve never had that problem, of people who need treatment within 28 days or they will deteriorate. That’s a big, big, big issue. P2 patients need to be treated within that time or harm will occur to the patient,” said the former NHS boss. The leader of England’s surgeons said Nicholson was right to describe the backlog so starkly. “The scale of the backlog for planned NHS surgery and other elective treatments is frightening – the largest it has ever been,” said Prof Neil Mortensen, the president of the Royal College of Surgeons of England. “Patients understand that many planned, less-urgent operations had to be postponed because of Covid, so that NHS staff could focus on the most urgent surgery, and looking after Covid patients. However, the longer the disruption to ‘normal’ NHS services continues, the larger the backlog of surgery, and the longer the waits. “We desperately need a clear and well-funded plan to deal with the backlog, otherwise NHS waiting times will become a huge political issue,” added Mortensen. It emerged on Thursday that Boris Johnson has appointed a former NHS high-flyer to advise him on how to improve the health service and social care. Samantha Jones, who ran two acute hospital trusts and was also NHS England’s director of new models of care, is joining the Downing Street policy unit as the expert adviser for NHS transformation and social care delivery. The Health Service Journal, which disclosed the move, also reported that No 10 had doubled the number of health advisers from two to four. It has also hired Adrian Masters, a former senior official at NHS Improvement, the Department of Health and Social Care and Downing Street, to advise on how to tackle the spiralling backlog of elective care. Many of the prime minister’s key pledges in the 2019 general election involved the NHS, such as recruiting 50,000 extra nurses and 6,000 more GPs and building 40 new hospitals in England. Deborah Ward, a senior analyst at the King’s Fund, said one in 12 people in England were already on the waiting list and that their number may start to rise quickly as lockdown restrictions lift and people become more ready to seek NHS help. “Polling consistently shows that waiting times matter to the public and are one of the most common reasons for dissatisfaction with the NHS. If waiting times continue to move in the wrong direction, the government could enter the next election with a growing share of the electorate on a hospital waiting list,” said Ward. In the interview, Nicholson also said the government’s impending shake-up of the NHS could prompt a lot of staff already exhausted by Covid to quit. “The issue is how many people are going to throw in the towel. If I think about the hospitals I’m responsible for, our real worry is that a whole lot of people just go – off the back of the pandemic and because they don’t want to go through another reorganisation – and that will create massive problems across the system … especially given the number of vacancies [85,000] we’ve got.” While recognising the difficult state of public finances, Nicholson also criticised the government’s handling of its 1% pay rise for NHS staff and said its insistence that frontline personnel were already well-rewarded could also trigger an exodus. “What people [staff] want is hope and encouragement. And they’re getting lectured by people about how well they are paid. At this particular moment in time, when people are making decisions about their futures and thinking about what they’re going to do, that’s just not a helpful place for us to be,” he said. A DHSC spokesperson said: “We are backing the NHS in our fight against this virus with an extra £7bn for health and care services, bringing our total additional investment to £29bn next year, with £3bn earmarked for supporting recovery and tackling NHS waiting lists. “Average waiting times for elective treatment have fallen by around 40% since July and we will continue to work with the NHS to ensure all patients receive the best possible care as quickly as possible.”