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

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)

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

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

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

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

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