This is a plain English summary of an original research article. The views expressed are those of the author(s) and reviewer(s) at the time of publication.
People waiting more than 18 weeks for NHS treatments used more healthcare resources than others, research found. Healthcare resource use differed depending on what treatment people were waiting for.
The researchers say initiatives to reduce waiting list backlogs should consider the extra healthcare use among people on the waiting list alongside the costs of the treatment.
More information about NHS waiting lists can be found on the NHS website.
The issue: what impact do long waiting lists have on healthcare use?
In March 2020, almost 4 million people were waiting for NHS treatment; by June 2024, this had risen to almost 8 million. Before the pandemic, the NHS met its target of treating people within 18 weeks of referral for 86% people. By March 2022, fewer people (62%) were treated in this time.
Understanding the healthcare use of people waiting for treatment helps to plan future healthcare resources. Researchers explored whether people waiting for treatment used more healthcare resources (such as GP appointments and prescriptions, community mental health consultations and calls to NHS 111) than those not waiting.
What’s new?
The researchers examined electronic health records for the Bristol, North Somerset and South Gloucestershire Integrated Care System (ICS). They included data on 44,616 people who had waited more than 18 weeks for elective (non-emergency) treatment between June and December 2021; their average age was 53 years. Each person waiting was matched with 200 others, on average, who had the same condition but were not waiting for treatment.
The study covered 18 hospital specialties, including general surgery, gynaecology, ophthalmology and trauma and orthopaedic.
Overall, people waiting for treatment used more healthcare resources than those who were not waiting, especially in some specialties. For example, compared with those not waiting for treatment:
- people waiting for general surgery (4,355 people) had an average of 2 more primary care prescriptions and 2 more secondary care contacts per year
- people waiting for gastroenterology treatment (2,185) had an average of 6 more primary care prescriptions and 2 more secondary care contacts per year
- people waiting for trauma and orthopaedic treatment (6,889) had an average of 2 more contacts with primary care, 4 more primary care prescriptions, and 4 additional contacts with secondary care per year
- people waiting for respiratory treatment (1,342) had an average of 5 more primary care prescriptions and 6 more secondary care contacts per year.
People waiting for cardiothoracic surgery had the largest increase in secondary care use (17 additional secondary care contacts per year compared to those not waiting for treatment). However, this represents less burden on the NHS than other specialties as few (29 people in this study) were waiting more than 18 weeks.
Those waiting for oral surgery, ophthalmology, gynaecology and dermatology services had the smallest increase in healthcare use (50% or more people waiting for these services did not use extra healthcare).
The greatest increases in healthcare use were in primary and secondary care contacts, and in prescriptions; the smallest were in helpline calls, emergency calls, community and mental health services (fewer than 25% people waiting used more of these services).
Why is this important?
The findings highlight the hidden costs of keeping people waiting for treatment. This will help decision makers determine care needs, minimise harm and support future strategic planning. Initiatives to reduce waiting lists need to factor in the costs of the procedure, along with additional resources used by people on the waiting list.
The number of people waiting over 18 weeks for treatment varied between specialties, but much of the extra demand for healthcare contact fell on secondary care. The researchers say that many of the extra prescriptions may have been repeat prescriptions, which represent an administrative burden on primary care.
The researchers caution that the study did not prove that differences in health service use were caused by long waits for treatment. The study matched people based on their health conditions, but did not account for the severity of those conditions.
What’s next?
The researchers presented their findings at meetings with Bristol, North Somerset, and South Gloucestershire Integrated Care Board (ICB). As a result, colleagues working within the Integrated Care system are considering how best to take the work forward. Further research will improve understanding of the system-wide impacts of waiting lists, and what initiatives might best reduce backlogs.
Can I act on these findings?
You may be interested to read
This is a summary of: James C, and others. The cost of keeping patients waiting: retrospective treatment-control study of additional healthcare utilisation for UK patients awaiting elective treatment. BMC Health Services Research 2024; 24: 556.
A press release by the Bristol Biomedical Research Centre summarising the study findings: Longer hospital wait times are leading to patients accessing more healthcare services.
Funding: This study was funded by the NIHR Applied Research Collaboration West.
Conflicts of Interest: No relevant conflicts were declared. Full disclosures are available on the original paper.
Disclaimer: Summaries on NIHR Evidence are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that the views expressed are those of the author(s) and reviewer(s) at the time of publication. They do not necessarily reflect the views of the NHS, the NIHR or the Department of Health and Social Care.
NIHR Evidence is covered by the creative commons, CC-BY licence. Written content and infographics may be freely reproduced provided that suitable acknowledgement is made. Note, this licence excludes comments and images made by third parties, audiovisual content, and linked content on other websites.
