Regional impact of Covid-19 on waiting lists

Published 7 September 2020


Edge Health analysis originally published by the HSJ

Revealed: the region where 1 in 4 of the population could be waiting for hospital care by April; George Batchelor; 10th August 2020


The NHS entered the Covid-19 crisis, with over 4.4 million people on the waiting lists for NHS funded treatment – about 8% of the population. As of May 2020, these people have waited for a collective 52 million weeks. For over 26,000 people it has been more than a year.

Relative to last year, there have been just under three million fewer referrals for treatment. When combined with some activity happening during the crisis period, the waiting list has got shorter. This drop in the size of the waiting list is temporary.

Productivity in operating theatres has also fallen with fewer cases per day – the time taken to get people in and operate has increased partly due to infection control measures. There has also been a shift to a higher proportion of urgent and complex activity that can take longer. Numbers are small, but theatre time in some areas increased by over 50% since March.

It is unclear if the whack-a-mole Covid-19 containment strategy will be able to prevent a second wave forming before winter. So, NHS England has set very challenging activity-based targets for trusts to achieve during the “window of opportunity” over the next few months (e.g. 90% of pre-Covid-19 activity levels by October 2020).

Edge Health analysis of the NHS England assumptions on the activity that should be completed over the next few months shows that the size of the waiting list could still grow to 8.4 million if targets are met, and all "Missing-In-Covid-19” activity returns over the next few months.

In addition to the NHS England targets the Royal College of Surgeons (RCS) has also put out (slightly different) guidance on what it considers might be possible. Edge health analysis based on these assumptions suggests the waiting list will increase to over 10 million.

Broken down by region, the South West would still have the shortest waiting list (although it would more than triple). The longest would be in the North West – growing from nearly one million to over two million.

If scaled to per head of population, up to 284 people (technically unfinished pathways) per 1,000 people in the North West could be on a waiting list by April 2021– over a quarter of the population.

The proposed focus on cancer, clinically urgent patients, and 52-week waiters may increase the acuity of the case-mix and operating times. It also signals a potentially significant shift towards prioritisation (there has always been some prioritisation).

The RCS set out criteria for prioritising activity in the wake of COVID-19. Variation in the interpretations of this guidance and waiting lists in general will support the shift towards regional waiting lists by region and the desire to create specialist centres. But the maths is clear that without investment in operating capacity, workforce, and a more effective way to access available capacity, some regions will be substantially worse off than others.

If this is the case, there should be increased focus on using as much information as possible to inform prioritisation decisions. Diagnostics will be critical to this information. There should also be an urgent, honest, and open discussion about how different activity is prioritised.

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