Blog

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

Dr Jonathan Pearson-Stuttard Partner & Head of Health Analytics

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)

10 CCGs with lowest number on waiting list in April 2021

Number of patients waiting more than 52 weeks

NHS NORTH EAST LINCOLNSHIRE CCG

60

NHS BLACKBURN WITH DARWEN CCG

108

NHS NORTH LINCOLNSHIRE CCG

115

NHS SOUTH TYNESIDE CCG

123

NHS WEST LANCASHIRE CCG

128

NHS SOUTHPORT AND FORMBY CCG

131

NHS NORTHUMBERLAND CCG

143

NHS GREATER PRESTON CCG

149

NHS NORTH TYNESIDE CCG

155

NHS CANNOCK CHASE CCG

173

10 CCGs with highest number on waiting list in April 2021

Number of patients waiting more than 52 weeks

NHS NORFOLK AND WAVENEY CCG

4,022

NHS DEVON CCG

3,700

NHS HAMPSHIRE, SOUTHAMPTON AND ISLE OF WIGHT CCG

2,694

NHS DERBY AND DERBYSHIRE CCG

2,607

NHS NORTH EAST LONDON CCG

2,506

NHS KENT AND MEDWAY CCG

2,351

NHS HEREFORDSHIRE AND WORCESTERSHIRE CCG

2,057

NHS DORSET CCG

1,817

NHS BRISTOL, NORTH SOMERSET AND SOUTH GLOUCESTERSHIRE CCG

1,797

NHS NORTH CENTRAL LONDON CCG

1,702

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

10 CCGs with lowest number on waiting list in April 2021

Patients waiting more than 52 weeks per 100,000 population

NHS SOUTH WEST LONDON CCG

15.9

NHS SURREY HEARTLANDS CCG

29.6

NHS NORTH EAST LINCOLNSHIRE CCG

37.6

NHS NORTH WEST LONDON CCG

42

NHS NORTHUMBERLAND CCG

44.4

NHS NORTHAMPTONSHIRE CCG

50.1

NHS VALE OF YORK CCG

52.4

NHS BLACK COUNTRY AND WEST BIRMINGHAM CCG

62.9

NHS FRIMLEY CCG

63.5

NHS NORTH LINCOLNSHIRE CCG

66.7

10 CCGs with highest number on waiting list in April 2021

Patients waiting more than 52 weeks per 100,000 population

NHS CASTLE POINT AND ROCHFORD CCG

507.5

NHS SOUTHEND CCG

427.6

NHS NORFOLK AND WAVENEY CCG

391.9

NHS BLACKPOOL CCG

388.7

NHS NORTH CUMBRIA CCG

365.4

NHS WEST SUFFOLK CCG

310.7

NHS DEVON CCG

308.1

NHS SHROPSHIRE, TELFORD AND WREKIN CCG

296.6

NHS EAST STAFFORDSHIRE CCG

287

NHS TAMESIDE AND GLOSSOP CCG

282.2

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

10 CCGs with lowest number on waiting list in April 2021

% of patients on waiting list waiting at least 52 weeks

NHS SOUTH WEST LONDON CCG

2.4

NHS SURREY HEARTLANDS CCG

2.5

NHS NORTH EAST LINCOLNSHIRE CCG

3.8

NHS GREATER PRESTON CCG

4.3

NHS EAST SUSSEX CCG

4.4

NHS BRIGHTON AND HOVE CCG

4.4

NHS BLACKBURN WITH DARWEN CCG

4.7

NHS NORTHUMBERLAND CCG

5.1

NHS CHORLEY AND SOUTH RIBBLE CCG

5.4

NHS FRIMLEY CCG

5.4

10 CCGs with highest number on waiting list in April 2021

% of patients on waiting list waiting at least 52 weeks

NHS NORFOLK AND WAVENEY CCG

27

NHS NORTH CUMBRIA CCG

26.6

NHS BLACKPOOL CCG

24.3

NHS LIVERPOOL CCG

24.2

NHS DEVON CCG

22.5

NHS CASTLE POINT AND ROCHFORD CCG

21.9

NHS DERBY AND DERBYSHIRE CCG

21.5

NHS TAMESIDE AND GLOSSOP CCG

21.4

NHS LEICESTER CITY CCG

21.4

NHS FYLDE AND WYRE CCG

21.3