Elective backlog and ethnicity

This project will examine if there is variation in "lost activity", time to treatment and treatment rates for common procedures between ethnic groups.


Published: 08/12/2021

Project status: Ongoing

The project

The aim of this project, which is being undertaken in collaboration with the NHS Race and Health Observatory, is to understand ethnic differences in access and waiting, within the context of the NHS’s Covid recovery plan for elective care.

The analysis will be undertaken using hospital data on people who have been treated.  We will use three measures which between them will provide a robust picture of ethnic variations in waiting and access to elective care.

Why it's important

The NHS is facing a significant backlog in elective treatment, with the waiting list for treatment in England standing at 5.7 million in August 2021.  The Covid-19 pandemic caused many elective treatments to stop, fewer referrals from GPs to secondary care, and reduced attendance at GP practices by patients.  While these effects were most pronounced during the first wave in 2020, their effects have persisted, and resulted in the waiting list growing even more rapidly than prior to Covid.  And it is expected that the waiting list will grow further, even if the NHS is able to recover or exceed capacity to pre-pandemic levels: there are likely to be people who have yet to come forward for treatment, due to the drop in referrals during the worst phases of the pandemic.

While NHS England and Improvement require NHS organisations to consider inequalities in access to treatment as they address the treatment backlog, it is not clear whether there are ethnic differences in access and waiting.

The covid 19 pandemic has exposed and amplified ethnic health inequalities. It is important that these are not replicated during the recovery phase.

What we'll do

The analysis will use Hospital Episode Statistics data on elective inpatient activity associated with a procedure.  We will identify high volume procedures or groups of procedures which cover a range of types of activity, for example, inpatient and day case, diagnostic and treatment, specialty, and age groups. 

We will develop three measures to examine ethnic differences:

  1. elective activity “lost” during the pandemic, which we will identify by comparison with activity in the year prior to the pandemic
  2. age and sex standardised treatment rates / 100,000 population
  3. time to treatment (time between referral and treatment for completed procedures), considering the mean, median or interquartile range, and % treated within 18 weeks

We will use pre-Covid data, along with data for the first year of Covid (March 2020 to February 2021), and the most recent data available (March 2021 to September 2021).

The main focus will be on variations between ethnic groups, using the most granular ethnic categories possible given the volume of procedures, and taking account of the quality of ethnicity coding.  We will also examine other relevant variables including admission type, deprivation decile and region.

The initial phase of the work will be descriptive. In the second phase of the work we will use multivariate methods to examine the relationship between time to treatment and ethnicity, region and deprivation. 

Project outputs

The main output from the work would be an independent report produced by the Nuffield Trust, in collaboration with the NHS Race and Health Observatory. 


The project will be undertaken between November 2021 and April 2022, with the first phase complete by January 2022.

Further information

For further information please contact sarah.scobie@nuffieldtrust.org.uk