Analysis reveals ‘hugely concerning’ disparities in waiting times between different patient groups in England

There are large differences between how long different groups of patients are waiting for NHS care in England, according to new research released today ahead of the publication of NHS England’s latest performance data.

In particular, analysis shows how people from the most deprived areas are much more likely to say they are waiting for planned care, young people of Black ethnicity experience longer waits in A&E, and those waiting for gynaecological care face a hugely increased waiting list.

With the government having firmly pledged to tackle health inequalities, the findings underline the crucial need to act on the issue as part of its forthcoming 10-year plan to fix the NHS.

New analysis from the Nuffield Trust and the Health Foundation, published by the QualityWatch joint research programme, looked into NHS England waiting times data on emergency[1] and planned[2] care, alongside the latest Office for National Statistics survey[3] asking patients about their waits.   

Breaking down these official and patient-reported waiting times by conditions and demographics – including age, ethnicity, sex and deprivation – the team expose the wide-ranging variations in care hidden in the national numbers. They found that:

• Up until the age of 40 Black patients consistently face longer waits in A&E than other ethnicities, with Black children and young adults between the ages of 0-19 waiting 21 minutes longer on average than white patients the same age
• The hospital waiting list for gynaecological care has more than tripled in the past ten years, from just under 185,000 patients in May 2014 to 597,000 in May 2024 (an increase of 223%)
• Patient-reported figures show 21% of people in England's most deprived areas say they have been waiting a year or more for NHS care, compared to 12% in the least deprived areas
• People presenting to A&E with psychological problems face the longest waits, whether or not they are admitted to hospital – with those who are not admitted facing a wait three hours longer than the non-admitted patient average
• Based on patient reporting, one-in-five (21%) of people in England are estimated to be waiting for an NHS appointment, test or treatment[4]

The QualityWatch analysis offers some insights into what lies behind the various health care disparities uncovered within waiting times data. For example, large increases in the number of people waiting for care relating to respiratory conditions over the past decade could be explained by Covid-19 and the ongoing impact of long-Covid on related services.

However, the researchers also highlight that the reasons for some of these disparities are not well understood or easily explained – for example the longer A&E waits for younger Black people. They suggest that further analysis and better data is needed to understand and tackle them, including the relationship between A&E waits and ethnicity, and whether this is influenced by structural racism in the NHS and wider society.

Addressing these inequalities, they argue, should form a core part of efforts by local and national leaders to improve care across the NHS.

Nuffield Trust Senior Fellow Dr Liz Fisher said:

“Month after month we see the stark reality of NHS backlogs and access issues in England reflected in the official data. Behind the headline numbers are millions of individual patients anxiously stuck on waiting lists, in pain and with a reduced quality of life or at risk of complications and even death due to delays in overcrowded A&E departments.

“When we dig down further into waiting times data, we see hugely concerning disparities. Inequitable access to health care continues to be very real, and how long patients wait for NHS care – whether urgent or planned – is widely different depending on what help they are waiting for, their age, sex, ethnicity and how deprived their local area is.

“Understanding these disparities is a first step to addressing them. Our approach can be replicated by local NHS organisations to better understand demographic issues and the needs of specific groups of patients in their own area. At a national level, the forthcoming 10-year health plan from Government presents a real chance to introduce policies that focus care for those most in need.”

Tim Gardner, Assistant Director of Policy at the Health Foundation, said:

“While the new government is committed to tackling NHS waiting times, these findings are another reminder of the enormity of the challenge it faces. Behind the headline figures of near-record waiting lists and many thousands of unsafe waits in emergency care are patients left in pain, and, in some cases, lives tragically lost.

“This analysis shows that some patients are more likely to be disproportionately hit by these delays, often those with more complex needs or people living in the most deprived parts of the country. As the government and the NHS develop plans to address waiting times, support and resources for improving services should be targeted in places with the greatest needs where people often face the longest waits.”

For further information or to arrange an interview, please contact the Nuffield Trust press office via press.office@nuffieldtrust.org.uk or call 020 7462 0500. 

References

1. QualityWatch used data from the NHS England Emergency Care Data Set, covering the period April 2022 to March 2024. This data set collects information on patients and their presentations at Type 1 and Type 2 A&E units.
    
2. For detail on waiting lists for referrals to consultant-led hospital care and incomplete patient pathways, Quality Watch used NHS England Referral-to-Treatment (RTT) Waiting Times data sets between May 2014-May 2024.
    
3. The latest ONS NHS waiting times survey, conducted between January-February 2024, polled more than 89,000 people aged 16 and over at the start of 2024 to find out more about patients experiencing “waiting for a hospital appointment, test, or to start receiving medical treatment through the NHS”.
    
4. More than a fifth (21%) of ONS survey respondents said they were waiting for planned NHS care – equivalent to 9.8 million people in the general population. This extrapolated figure is greater than the RTT patient waiting list size for planned hospital care – likely reflecting patients’ experiences of waits not captured by the RTT data set (such as non-consultant care and follow-up appointments) and care delivered outside of hospital.