13 March 2023
New analysis by LCP of NHS waiting lists in England over one year since the launch of the government’s Elective Recovery Plan (ERP) shows that regional inequality is growing when it comes to healthcare access. There is a 29% difference in the number of people waiting in the most and least affected regions, and LCP predicts that even in the best-case scenario, waiting lists will peak at 7.3 million this month, equating to 1 in 8 adults.
The East of England (12,918 per 100,000 people) has the most people waiting for elective care, and the South East has the least (10,022 per 100,000 people). The South-East has also seen 18-month waits reduced by 51% compared to the Midlands, which has seen only a 20% reduction so far.
The analysis also highlighted that if regional disparities aren’t addressed inequalities, in health access will worsen. Particular areas of concern are in places that are likely to have a large number of people who have yet to come forward for treatment because of the impact of the pandemic, and this is on top of the number already waiting. Four of the top six areas of the country facing the most of this so-called ‘unmet need’ are clustered together in the North West and Midlands:
- NHS Black Country
- NHS Cheshire and Merseyside
- NHS Staffordshire and Stoke-on-Trent
- NHS Greater Manchester.
This also represents a political challenge. Constituencies won by the Conservatives from Labour in the 2019 general election are concentrated in these areas where unmet need is far above the national average.
For example, Bury North constituency, where the Conservatives hold only 0.22% (105 votes), the majority has unmet health needs 12% above the national average. The Heywood and Middleton constituency has unmet health needs 26% above the national average, where the Conservatives hold a 1.4% (663 votes) majority.
The scale of the challenge
Current evidence suggests that the NHS is unlikely to achieve its planned increase in capacity as outlined in the ERP. For instance, even if only two-thirds of the planned increase in capacity is achieved, waiting lists could be expected to peak at 7.9 million people in July 2023. This only reduces lists to 3.5 million people in October 2025, leaving an additional 2 million waiting for NHS elective treatment compared to if ERP targets are hit. Yet even achieving a two-thirds increase in capacity appears ambitious. At the end of 2022, monthly inpatient capacity was 3% less than pre-Covid levels, whilst outpatient capacity was only 2% more than pre-Covid levels.
18 weeks wait is still out of reach for many
Despite the increase in waiting list numbers, the longest wait times in most regions and specialities have been reduced, as only 2 people for every 100,000 were recorded in November 2022, waiting 2 years for elective care. However, the analysis shows there has been a 26% increase in patients waiting longer than 18 weeks since the launch of the government’s plan, from 2.3 million in February 2022 to 2.9 million in November 2022. Yet, it may not be until 2025 when we can appraise how the ERP has affected the NHS' aim of reducing waiting times to 18 weeks, according to LCP.
Specialist areas facing the biggest challenges
Orthopaedics and Gynaecology have seen the most challenges regarding waiting list times. The analysis shows that Orthopaedics is the clinical speciality with the largest population-adjusted waiting lists, with 1,386 per 100,000 people in November 2022, an increase of 60% since March 2020. Despite improvements over the previous year in those waiting longer than 52 weeks for care, 59,000 patients have been waiting more than a year for orthopaedic treatment.
As of November 2022, gynaecological waiting lists have increased from 489 per 100,000 people across England in March 2020 to 963 per 100,000, representing a nearly 100% increase since the beginning of Covid-19.
Dr Jonathan Pearson-Stuttard, Head of Health Analytics at LCP, said: “The most difficult milestones lie ahead when it comes to tackling the waiting list. It’s significant that more people are waiting longer than 18 weeks as it is mandated that this should be the maximum waiting time for non-urgent, consultant-led treatments. Whilst the NHS has done well in addressing the 'low-hanging fruit' of exceptionally long waiters, much more needs to be done to improve overall NHS capacity and ensure this is equitable across conditions and geography.”
Robert King, Associate Consultant at LCP, added: “In the context of patients with increasingly complex, chronic conditions, coupled with ongoing financial and workforce pressures, the NHS needs to find innovative ways to strengthen capacity and address inequities. Alongside this, it is clear that the East of England, Midlands and areas in the North West are being left further behind, and policymakers can help move the needle by proportionately targeting resources and support to areas with the greatest need.”