Waiting times for major surgery slower to recover in England than in similar countries

New analysis from the Nuffield Trust looks at how waiting times have changed in England and in other countries since the peak of the Covid-19 pandemic.

Press release

Published: 11/07/2024

The NHS in England is lagging behind other high-income countries on how quickly it is recovering from the pandemic when it comes to average (median) waiting times for hip and knee replacements. That’s according to new analysis from the Nuffield Trust which looks at how average waiting times for three common procedures have changed across 10 high-income countries.  

For hip and knee replacements, average (median) waiting times in England rose more substantially relative to other countries like Spain and Finland and remained stubbornly high into 2023. England’s hip replacement waits are still 50% longer than before the pandemic. 

The NHS has worked through the backlog quickly for less intensive cataract operations. But there are particular weaknesses in the health service around treatment for orthopaedic surgery that requires more support from staff and overnight stays. This is in spite of the fact that roughly half of hip and knee replacements are already carried out in the private sector. 

The Nuffield Trust says that structural vulnerabilities that the NHS had going into the pandemic have made waiting time recovery a challenge for major surgeries. England has fewer hospital beds, lower numbers of key staff and lower levels of investment in buildings and equipment than many other high-income countries, and this is likely to have affected how quickly the millions of people waiting can have the surgery they need to live comfortably. 

The analysis reviews the latest data to understand how waiting times have changed in England and in other countries since the peak of the pandemic, focusing on the difference in average waiting times pre- and post-Covid (spanning 2017 to 2023). It looks at other high-income countries with comparable health systems and recent data included in OECD health statistics. As the UK has not submitted data to the OECD since 2020, the Nuffield Trust has analysed hospital episode statistics to provide a comparable benchmark for England.  

The Nuffield Trust analysis of recovery across the three procedures finds that:

  • In England, average waiting times for hip replacements jumped from around 87 days before 2020 to 180 days in 2020. For the three subsequent years average waits have remained around 128 days, nearly 50% longer than pre-2020. Countries such as Canada and Australia have also recovered poorly. Other countries in the analysis have performed better, including Spain and Finland who saw little change in hip replacement waiting times post-2020 compared to pre-2020. In Norway and Sweden, median waits have also increased compared to their pre-pandemic level, but to a lesser degree than England. 
  • England has similarly struggled with knee replacement waiting times. Average waits rose from around 91 days before 2020 to 209 days in 2020, and in the three years since have remained around 142 days. Post-2020 median waits for knee replacement in Spain, Italy, Portugal and Finland appeared to be similar to, or shorter, than before the pandemic.  
  • However, England is ahead of the pack for cataract surgeries – average waiting times have improved quicker than nearly everywhere else. These procedures don’t require overnight stays and extensive rehabilitation, so it has been easier to return them to pre-pandemic levels, with staffing issues having less of an impact than on orthopaedic surgeries.  

The analysis notes that while England has performed poorly in terms of the change in average waiting times pre- and post-pandemic, the actual amount of time people wait for treatment on average appears to be shorter in England than in several countries.  

Sarah Reed, Nuffield Trust Senior Fellow, said: 

“Health systems all over the world are still dealing with the effects of the Covid-19 pandemic, with many still struggling to bring down waiting times. However, it’s striking that in England our pace of recovery has been much slower for major surgeries like hip and knee replacements, but for some minor procedures we appear to have improved more quickly than nearly everywhere else.  

“This should raise a host of important questions for the new government on what it will take to get ahead of the elective backlog and reinforces how for procedures that require the whole system to work well together we’re really falling short.” 


Notes to editors

  • The analysis is limited to other high-income countries with comparable health systems and recent data included in OECD health statistics. The comparator countries are:  Italy, Spain, Finland, Portugal, Sweden, Norway, Australia, Canada , New Zealand
  • This analysis is primarily focused on how median waiting times changed over seven years, spanning pre- and post-Covid periods (2017 to 2023).  
  • The median waiting time is defined as the number of days which divides the waiting population in half: 50% waited fewer days than the median, 50% waited more.  
  • The analysis focuses less on the absolute waiting times for different countries (to better account for definitional differences), but rather how median waiting times have changed in each country post-2020 versus pre-2020.
  • It uses OECD health statistics for each country except England, which have been calculated using NHS England Hospital Episode Statistics (HES).  OECD health statistics only cover up to 2022, but for England we have calculated an additional year 2023. England data derived from HES data include NHS patients treated in both NHS and private hospitals. 
  • The OECD and HES-derived waits are waiting times from specialist assessment to treatment. As such they only tell us about the waits for individuals who have received treatment in each year.   
  • The Nuffield Trust is an independent health think tank. We aim to improve the quality of health care in the UK by providing evidence-based research and policy analysis and informing and generating debate www.nuffieldtrust.org.uk
  • For all queries or to arrange an interview, contact our press office: press.office@nuffieldtrust.org.uk; or 020 7462 0500.