Chart of the week: Recovery on waiting times levelling off as England's regions balance Covid and non-Covid treatment

Each week we present analysis of data in chart form to illustrate some key issues and invite discussion. This week, Sarah Reed and Jenny Davies look back at how waiting times for planned treatment have been holding up across England over recent months as the NHS has juggled the need to maintain routine care alongside a devastating second wave of Covid-19.

Data story

Published: 18/02/2021

One of the many costs of the pandemic has been the distressing rise in patients waiting for care. There are now 4.6 million people waiting to start planned treatment with a consultant, among whom 32% have been waiting more than 18 weeks – four times the national target.

When we look at how waiting times have been affected by Covid-19 over time, three things stand out.

Firstly, while the NHS made enormous strides to resume activity and reduce waiting times when cases fell in the summer and autumn, that pace of recovery has now levelled off in all regions. This highlights the severe pressure hospitals have been under to balance Covid and non-Covid care during winter and the latest surge of cases. Covid-19 hospitalisations are now falling nationally, but there’s a risk that wait times will be slower to improve this time around given the cumulative toll the pandemic has had on staff and the sustained number of hospitalisations relative to the first wave.

Next, we see regions following a similar trend throughout the pandemic, despite differences in the geographical spread of the virus.  This was unsurprising in the months during and following the first wave given decisions to nationally to stand down elective services.1 But this pattern has continued, even though trusts in the most severely affected areas started scaling back elective procedures from October. 

This regional picture could mask important variation within areas at the trust level, and we still don’t know the full impact of the current wave. Regions face different challenges and options in managing the backlog, and more variation could emerge as trusts resume care at different rates. For example, ongoing partnerships with the independent sector may help expand elective capacity in areas like London where there’s a greater concentration of private hospitals. But this isn’t a viable option everywhere.

Lastly, patients awaiting care commissioned centrally have seen the largest increases to wait times by far. While most services are planned and arranged for locally, NHS England commissions services for rare and complex conditions, typically in areas where specialist care may not be available locally.

Before the pandemic, waiting times for these services were not so different from locally commissioned ones. However, by the peak in July, the percentage of patients waiting over 18 weeks for NHS England-commissioned treatment reached 69%, compared to 50­–53% for locally commissioned services. The waiting times for nationally commissioned services have remained highest, with 41% of patients waiting over 18 weeks in December. This suggests that care backlogs and delays are having a disproportionate impact on patients with the most complex needs, and should be cause for grave concern.

People waiting over 18 weeks for treatment 18/02/2021



*NHS England commissions services both regionally and nationally for a range of rare and complex conditions.
Regions refer to the region of the clinical commissioning group.

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1.  National guidance set expectations that providers would recommence urgent elective services from 29 April 2020, and reach near-normal levels of activity by autumn.