ONS report highlights challenges in comparing UK-wide NHS waiting times

Understanding the state of the NHS requires navigating a complex web of data that varies significantly depending on where a patient resides. A report from the Office for National Statistics (ONS), published on 18 June 2024, has highlighted the substantial challenges in comparing waiting times across the UK’s devolved healthcare systems. These disparities stem from fundamental differences in commissioning, patient data collection, and clinical policy, making direct comparisons between the four nations difficult and often misleading.

The core of the issue lies in how each country tracks the patient journey from referral to treatment. England and Wales both produce data on open Referral to Treatment (RTT) pathways, which track patients currently waiting for their care. However, Scotland and Northern Ireland report on specific stages of the treatment pathway, such as waiting for a first outpatient appointment or an inpatient admission. Crucially, the Ons notes that adding these separate stages together does not create an equivalent figure to the total RTT waiting lists monitored in England or Wales.

The ONS report, developed in partnership with health bodies from all four nations, explains that these systems were originally designed for operational management rather than cross-border statistical analysis. Consequently, policies regarding the "waiting time clock"—the point at which a patient's wait is recorded as starting or stopping—differ significantly. For instance, whether a patient's time on a list is adjusted if they fail to attend an appointment or are unavailable for treatment varies, creating distinct patterns in how performance is reported.

To aid clarity, the ONS provided a comparison of the primary standards each nation uses:

• England: 92% of patients should not wait longer than 18 weeks from referral to treatment.
• Scotland: 95% of patients should be seen at a new outpatient appointment within 12 weeks, and 100% of patients should wait no longer than 12 weeks for treatment as an inpatient or day case.
• Wales: 95% of patients should start treatment following referral within a 26-week target.
• Northern Ireland: 50% of patients should wait no longer than 9 weeks for a first consultant-led outpatient appointment, 55% of patients should wait no longer than 13 weeks for an agreed inpatient and day case admission and no patient should wait longer than 52 weeks.

The report underscores that these figures cannot be directly compared because the underlying definitions of what constitutes a "pathway" differ. In England, statistics focus strictly on consultant-led care. Wales includes some non-consultant led pathways, such as Allied Health Professional therapies. When these specific non-consultant services are removed from the Welsh data, the figures become more broadly comparable with those in England, though other variables like regional population health profiles still complicate the picture.

Geographical and societal factors also play a role in shaping these waiting times. The ONS points to differences in the rural-urban split, which affects how easily patients can reach hospital services, as well as varying levels of deprivation and age profiles across the nations. These factors influence how frequently different populations interact with their local healthcare services, such as those overseen by NHS Highland.

The impact of the COVID-19 pandemic remains a common thread across all four nations, with significant increases in the size of waiting lists and the number of patients waiting longer than 52 weeks noted post-lockdown. While the trajectories differ, the upward trend in patients waiting for care has been consistent since 2011.

For patients currently navigating the system, the Myplannedcare portal offers resources to help individuals manage their health while they wait for consultations or surgery. The site allows patients to view information about waiting times at their specific hospitals and find support services. Patients are encouraged to use these online tools for updates before contacting their GPs or local hospitals directly.

Looking ahead, health bodies continue to monitor data quality and definitions in accordance with the Code of Practice for Statistics. The ONS has indicated that as policy documentation evolves, its assessments of how data can be compared may change.

What to watch next

• Updates to national policies as health bodies continue to review data collection methods.
• Future ONS releases aimed at creating a more "coherent picture of health in the UK" through ongoing cross-government partnerships.
• Further analysis into why the disparities in waiting lists between Scotland and Northern Ireland remain, even when accounting for different policy approaches.