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Waiting list numbers tell stories of inequality and some very long waits

Dr Jonathan Pearson-Stuttard Partner & Head of Health Analytics
Sara Holloway Senior Consultant

When it comes to NHS waiting lists, it is easy to focus on some of the (very) big numbers - the 5.1 million people currently on a waiting list, or the 385,490 people waiting for more than a year for treatment (up from around 1,600 before the pandemic). However, when analysing population level data, it can be easy to overlook the relatively small numbers at the extremes, yet it is these that represent people spending substantial periods in pain or discomfort.

The increases in waiting list size and average waiting time are an indirect impact of the Covid-19 pandemic, during which focusing NHS resources on Covid-19 has negatively impacted other care pathways, both routine and urgent. Crucially, just as the direct impacts of the pandemic were felt unequally, so too are the indirect impacts.

We launched our NHS Waiting List Tracker to look more closely at waiting lists, how they have increased since the pandemic began, and how this increase has been felt unequally across specialty and region. Analysing how the waiting lists vary can help identify populations and areas with the highest unmet need, and this information can be used to prioritise resources and tackle the backlog most effectively, improving population health and reducing inequalities. Each number represents an ‘incomplete pathway’ which is an individual referral on a waiting list. A patient may be referred for more than one treatment hence the number of individual patients on any waiting list may be slightly lower than the number of incomplete pathways. For ease of reading we use ‘patients’ throughout this article when referring to incomplete pathways.

Almost 65,000 people are waiting at least 18 months for treatment

The April 2021 waiting time data shed a clearer light on the very long waiters – those waiting more than 52 weeks for treatment. Previously, the data only included a ‘more than 52 weeks’ category, but the latest data provides more granularity and detail. The new data incorporates one-week groupings, which allows us to analyse the numbers of patients waiting more than 18 months and more than two years.

As of April 2021, there were 64,959 people waiting more than 18 months for treatment, and 2,722 waiting more than two years. These numbers are extremely worrying, because they represent individuals suffering the very worst physical and mental effects of persistent ill-health and pain. The inequalities across CCGs in England, however, are more alarming still.

There is a 100-fold difference in numbers waiting 18 months for treatment across CCGs

In April 2021, there were approximately 3,000 people waiting more than 18 months for treatment in Norfolk and Waveney and North East London – more than 100 times higher than the number in Bassetlaw (25) and Barnsley (29) (Table 1). The disparity reduces from a 100-fold difference to an approximate 40-fold difference when accounting for population size (Table 2) which, while important for identifying potential reasons for such vast inequalities, does not dismiss the scale of the challenge facing local health systems and inequalities felt by patients and populations.

Things are equally bad for those waiting two years

When looking at the numbers of patients waiting more than two years for treatment, the inequalities persist. Waiting more than two years for treatment should, of course, be extremely rare, hence pulling meaningful comparisons can be difficult. However, out of the 106 CCGs in England there are at least four we can identify with more than 100 patients waiting more than two years for treatment, three of which are in London – North Central London (259), North East London (159) and South East London (140) – along with Devon (103). In contrast, there are 15 CCGs with just two or fewer patients waiting more than two years.

The data shines a light on outliers and areas of most unmet need

The current waiting list of 5.1 million will continue, rightly, to garner attention and policy focus. So too will population measures such as the average waiting time for each specialty, and our work has highlighted the importance of using the data to identify inequalities across CCGs and regions when allocating resources and trying to address inequalities.

However, it is also critical to use the data to highlight the outliers – those waiting a very long time for treatment. While a relatively small number of patients compared with the total waiting list, these are perhaps the people who have suffered the most, since waiting for such long periods is likely to have exacerbated their existing physical and mental health conditions further still. They must not be forgotten in the push to drive the big numbers down.

Data and statistics

Table 1: Number of incomplete pathways waiting more than 78 weeks (18 months) for All Specialties (Absolute numbers)

10 CCGs with highest number on waiting list in April 2021

Number of incomplete pathways waiting more than 18 months

NHS NORFOLK AND WAVENEY CCG

3137

NHS NORTH EAST LONDON CCG

2929

NHS BIRMINGHAM AND SOLIHULL CCG

2256

NHS NORTH CENTRAL LONDON CCG

2197

NHS DEVON CCG

2069

NHS MANCHESTER CCG

1655

NHS SOUTH EAST LONDON CCG

1546

NHS DERBY AND DERBYSHIRE CCG

1394

NHS NORTH WEST LONDON CCG

1270

NHS HEREFORDSHIRE AND WORCESTERSHIRE CCG

1268

10 CCGs with lowest number on waiting list in April 2021

Number of incomplete pathways waiting more than 18 months

NHS BASSETLAW CCG

25

NHS BARNSLEY CCG

29

NHS SOUTHPORT AND FORMBY CCG

29

NHS WEST LANCASHIRE CCG

37

NHS PORTSMOUTH CCG

39

NHS SOUTH TYNESIDE CCG

48

NHS GLOUCESTERSHIRE CCG

65

NHS ST HELENS CCG

68

NHS NORTH EAST LINCOLNSHIRE CCG

81

NHS DONCASTER CCG

85

Table 2: Number of incomplete pathways waiting more than 78 weeks (18 months) for All Specialties (Numbers per 100,000)

10 CCGs with highest number on waiting list in April 2021

Incomplete pathways waiting more than 18 months per 100,000 population

NHS HULL CCG

450.4

NHS CASTLE POINT AND ROCHFORD CCG

364.6

NHS SOUTHEND CCG

360.4

NHS NORFOLK AND WAVENEY CCG

305.7

NHS MANCHESTER CCG

299.4

NHS EAST RIDING OF YORKSHIRE CCG

277.3

NHS BLACKPOOL CCG

268.9

NHS WEST SUFFOLK CCG

241.7

NHS LEICESTER CITY CCG

237.7

NHS EAST LEICESTERSHIRE AND RUTLAND CCG

223.3

10 CCGs with lowest number on waiting list in April 2021

Incomplete pathways waiting more than 18 months per 100,000 population

NHS GLOUCESTERSHIRE CCG

10.2

NHS BARNSLEY CCG

11.7

NHS FRIMLEY CCG

16.0

NHS SURREY HEARTLANDS CCG

17.3

NHS PORTSMOUTH CCG

18.1

NHS SHEFFIELD CCG

18.3

NHS BASSETLAW CCG

21.3

NHS SOUTHPORT AND FORMBY CCG

25.0

NHS BERKSHIRE WEST CCG

25.4

NHS SOUTH WEST LONDON CCG

26.6

Table 3: Number of incomplete pathways waiting more than 78 weeks (18 months) for All Specialties (% of waiting list)

10 CCGs with highest number on waiting list in April 2021

% of incomplete pathways waiting more than 18 months

NHS HULL CCG

4.2

NHS SOUTHEND CCG

3.3

NHS CASTLE POINT AND ROCHFORD CCG

3.3

NHS NORFOLK AND WAVENEY CCG

3.3

NHS EAST RIDING OF YORKSHIRE CCG

3.0

NHS BUCKINGHAMSHIRE CCG

2.8

NHS BLACKPOOL CCG

2.6

NHS LEICESTER CITY CCG

2.6

NHS EAST LEICESTERSHIRE AND RUTLAND CCG

2.6

NHS WEST SUFFOLK CCG

2.6

10 CCGs with lowest number on waiting list in April 2021

% of incomplete pathways waiting more than 18 months

NHS GLOUCESTERSHIRE CCG

0.1

NHS FRIMLEY CCG

0.2

NHS BARNSLEY CCG

0.2

NHS SURREY HEARTLANDS CCG

0.2

NHS SOUTHPORT AND FORMBY CCG

0.3

NHS SHEFFIELD CCG

0.3

NHS DONCASTER CCG

0.3

NHS BASSETLAW CCG

0.3

NHS BERKSHIRE WEST CCG

0.3

NHS PORTSMOUTH CCG

0.3

Table 4: Number of incomplete pathways waiting more than 104 weeks (2 years) for All Specialties (Absolute numbers)

10 CCGs with highest number on waiting list in April 2021

Number of incomplete pathways waiting more than 2 years

NHS NORTH CENTRAL LONDON CCG

259

NHS NORTH EAST LONDON CCG

159

NHS SOUTH EAST LONDON CCG

140

NHS DEVON CCG

103

NHS NORTH WEST LONDON CCG

91

NHS NORFOLK AND WAVENEY CCG

84

NHS CASTLE POINT AND ROCHFORD CCG

75

NHS HERTS VALLEYS CCG

74

NHS SOUTHEND CCG

72

NHS EAST AND NORTH HERTFORDSHIRE CCG

66

10 CCGs with lowest number on waiting list in April 2021

Number of incomplete pathways waiting more than 2 years

NHS FRIMLEY CCG

1

NHS WEST LANCASHIRE CCG

1

NHS SOUTH SEFTON CCG

1

NHS KNOWSLEY CCG

1

NHS ROTHERHAM CCG

1

NHS DONCASTER CCG

1

NHS BERKSHIRE WEST CCG

1

NHS BLACKBURN WITH DARWEN CCG

2

NHS WIRRAL CCG

2

NHS SOUTHPORT AND FORMBY CCG

2

Table 5: Number of incomplete pathways waiting more than 104 weeks (2 years) for All Specialties (Numbers per 100,000)

10 CCGs with highest number on waiting list in April 2021

Incomplete pathways waiting more than 2 years per 100,000 population

NHS CASTLE POINT AND ROCHFORD CCG

42.2

NHS SOUTHEND CCG

39.3

NHS NORTH CENTRAL LONDON CCG

17.1

NHS LEICESTER CITY CCG

16.9

NHS NORTH CUMBRIA CCG

13.8

NHS BLACKPOOL CCG

13.6

NHS EAST LEICESTERSHIRE AND RUTLAND CCG

12.4

NHS HERTS VALLEYS CCG

12.4

NHS EAST AND NORTH HERTFORDSHIRE CCG

11.5

NHS MANCHESTER CCG

11.4

10 CCGs with lowest number on waiting list in April 2021

Incomplete pathways waiting more than 2 years per 100,000 population

NHS FRIMLEY CCG

0.1

NHS BERKSHIRE WEST CCG

0.2

NHS SHEFFIELD CCG

0.3

NHS DONCASTER CCG

0.3

NHS LIVERPOOL CCG

0.4

NHS ROTHERHAM CCG

0.4

NHS GLOUCESTERSHIRE CCG

0.5

NHS WIRRAL CCG

0.6

NHS SOUTH SEFTON CCG

0.6

NHS KNOWSLEY CCG

0.7

Table 6: Number of incomplete pathways waiting more than 104 weeks (2 years) for All Specialties (% of waiting list)

10 CCGs with highest number on waiting list in April 2021

% of incomplete pathways waiting more than 2 years

NHS CASTLE POINT AND ROCHFORD CCG

0.4

NHS SOUTHEND CCG

0.4

NHS NORTH CENTRAL LONDON CCG

0.2

NHS LEICESTER CITY CCG

0.2

NHS HERTS VALLEYS CCG

0.2

NHS NORTH CUMBRIA CCG

0.2

NHS EAST LEICESTERSHIRE AND RUTLAND CCG

0.1

NHS BLACKPOOL CCG

0.1

NHS MID ESSEX CCG

0.1

NHS EAST AND NORTH HERTFORDSHIRE CCG

0.1

10 CCGs with lowest number on waiting list in April 2021

% of incomplete pathways waiting more than 2 years

NHS FRIMLEY CCG

0.002

NHS BERKSHIRE WEST CCG

0.002

NHS DONCASTER CCG

0.004

NHS LIVERPOOL CCG

0.005

NHS SHEFFIELD CCG

0.005

NHS ROTHERHAM CCG

0.005

NHS GLOUCESTERSHIRE CCG

0.005

NHS SOUTH SEFTON CCG

0.006

NHS WIRRAL CCG

0.007

NHS KNOWSLEY CCG

0.007