Larger waiting lists and longer waits – a worrying indirect impact of the Covid-19 pandemic

We have been analysing and discussing the indirect impacts of the Covid-19 pandemic since early 2020. Of particular concern has been how the health system’s resilience has been tested, and where pivoting to focus on Covid-19 has negatively impacted other care pathways, both routine and urgent. We find that specialist care pathways, where patients are referred into secondary care via waiting lists, have been severely impacted since the pandemic began.

The NHS standard is to be seen within 18 weeks of referral for a wide range of conditions across a range of specialties, including orthopaedics, gynaecology, urology, ear, nose and throat, and many more. Due to the pandemic, there are now around 5 million people currently on a waiting list, the highest number since 2007, and many have been waiting longer than 18 weeks. More worrying still is the vast increase in the number of people waiting more than a year, 52 weeks, before beginning treatment.

The direct and indirect impacts of Covid-19 on waiting lists vary greatly according to geographical area and specialty

Crucially, the large increases in both size of waiting list and average wait time are not uniform; they differ greatly across different specialties and across the country. A better understanding of the size and compositions of waiting lists in different areas will help providers to better focus resources.

We have developed the LCP NHS Waiting List Tracker to enable policy makers, those working in the NHS, patients and relatives to easily explore waiting lists in their Clinical Commissioning Group (CCG) area, see how they compare to neighbouring CCGs and the national average, and how the situation has changed over time.

We have also developed a function where users can create their own scatter graph to see how waiting list times (in total or by speciality) vary in CCGs across England according to age, deprivation score and population size. The tracker brings together publicly available data from NHS digital, and the data sources and our approach are outlined in more detail here.

Big numbers mask big differences

Understandably, much coverage has focused on the large increase in the number of people on waiting lists with an average waiting time of 12 weeks (under the 18-week target), which was 5.1 million in April 2021, up by 886,000 since March 2020. But this doesn’t capture the exponentially increasing number of patients waiting more than one year to begin treatment. In February 2020, this figure was just 1,600, in April 2021 it had reached more than 385,000 people, which was a 12% decline since March.

Orthopaedics currently has the highest number of people on a waiting list at approximately 646,000. Of this number, around one in eight people (81,000) have been waiting more than a year, but the distribution varies substantially across the country. For example, 4,022 people in Norfolk and Waveney CCG are waiting more than 52 weeks for Orthopaedics compared to 60 in North East Lincolnshire CCG, nearly 70 times more (although when adjusted for population size, this gap reduces). Elsewhere, there is a 30-fold difference in the numbers waiting more than a year between South West London CCG (16/100,000) and Castle Point CCG (508/100,000). In Ealing, only 1 in 40 on the waiting list will be waiting 52 weeks or more compared to around 1 in 4 in Norfolk, North Cumbria and Blackpool CCGs.

The increases differ not only geographically, but also across specialties. From March 2020 to April 2021, the total number on waiting lists increased by approximately 21%, and increases have been observed across 14 of the 19 specialities included in the tracker. Within this average, however, the Dermatology waiting list has increased by 2% while that for Gynaecology has risen by 38%.

Timely data can help target resources to where they are needed most

The Health Index, which represents the stock of health of local areas and nationally, already varied substantially before the pandemic, and the direct impacts of Covid-19 have been felt unequally according to geography, deprivation, ethnicity and age. To mitigate further worsening of health inequalities, efforts to level-up health should harness a data-driven approach to identifying patients with the highest unmet need in order to prioritise targeted interventions.

Data and statistics

Table 1: Number of patients waiting more than 52 weeks for Orthopaedics (Absolute numbers)

Table 2: Number of patients waiting more than 52 weeks for Orthopaedics (Numbers per 100,000)

Table 3: Number of patients waiting more than 52 weeks for Orthopaedics (% of waiting list)