WHAT are the consequences of waiting list backlogs in the NHS?

It is a question worth asking given that people are waiting longer than ever on the NHS, and – in Scotland – our progress in cutting extremely long waits of two-plus years appears to have stalled.

Waiting... and waiting

By the end of March this year, there were 6,985 people on inpatient/day case lists for an elective procedure on the NHS who had been waiting for more than two years.

This is a pretty embarrassing statistic for the Scottish Government given that it pledged in July last year that two-year waits for operations would be eradicated "in most specialties" by the end of September 2023 (the vagueness of "most specialties" has already been criticised by Audit Scotland).

Even more awkward for ministers is the fact that this figure has actually increased since the end of November (when it dipped to 6,712).

More staggering still is the fact that England – with 10 times the population – has already cut the size of its two-year wait list to just 559 patients.

England is even ahead of us in reducing the number of people who have been waiting 18-plus months for a procedure: 10,737 versus 17,147 in Scotland.

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The Scottish Government has until the end of September this year to make good on its promise of eradicating these 18 month waits, but the chances are frankly nil.

Exactly why Scotland has ended up lagging so far behind is not completely clear, but the likeliest explanations include greater use of the private sector south of the border (England has more private hospital beds per head of population than Scotland anyway, and a political bias in favour of utilising it), as well as the delayed rollout of Scotland's national treatment centre hubs (only two have opened so far, and five are unlikely to be ready until 2027 or later).

The health service in England also operates within a controversial system of financial penalties and incentives that rewards trusts which achieve targets for elective activity.

Drilling down into the waiting list figures for Scotland, four specialties account for more than 80% of the patients with the longest waits: one in three (33 per cent) of those waiting two-plus years – 2,289 patients – are on orthopaedic lists; 1,035 (15%) are on urology lists; 1,037 (15%) are waiting for an Ear, Nose & Throat (ENT) procedure; and 1,224 (17.5%) are on general surgery lists.

Died waiting?

There are a few ways that patients can be removed from waiting lists: undergoing treatment; going private; being cancelled (for example, due to 'no-shows'); recovering without treatment; or dying.

In 2022, around 19,000 people in Scotland paid for private medical treatment out of their own pocket (i.e. without insurance) – up from 11,000 in 2019. Not all of these patients will have been on an NHS list to begin with, but thousands will have. In NHS Grampian, 2,030 patients were removed from its waiting lists in 2022/23 because they had gone private instead.

The number of people dying while on NHS waiting lists has also increased, from 13,211 in 2019 to 18,390 in 2022 (up 39%). That is not to say that all of these people died because they had waited too long for treatment, but there is no doubt that thousands of people are becoming sicker and suffering complications due to these delays.

In March 2019, the median waiting time for an inpatient/day case procedure was 48 days; by March this year it was 171.

The total number of people on these lists has also ballooned over that same period, from 76,322 to 147,241.

The Herald:

On the frontline

If anyone sees the consequences of these long waits it is the doctors in A&E and in GP surgeries.

Dr Lailah Peel, a junior doctor working in emergency medicine in Glasgow, told me she has "lost count of the number of patients I’ve seen who are presenting in [the emergency department] with complications whilst they’ve got a year or more to wait for their operation".

A radiologist told me his disabled son has been waiting nine months for a filling through NHS Lothian's special dentistry service, but has yet to get an appointment.

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GPs describe their frustration in being faced day after day with patients they can do little or nothing to help.

One based in the Highland region said he had handled "multiple attendances" in his own practice recently from patients on waiting lists for specialist outpatient clinics who were looking to him to fast-track their appointments.

He added that even in the case of urgent gynaecology referrals in post-menopausal women with bleeding – a potential red flag for cancer – the waiting time from referral to first hospital appointment is now 11 weeks.

The problem is that unless a patient has experienced a "significant unexpected change" since their initial referral, GPs are powerless to speed anything up.

Another, based in the Greater Glasgow and Clyde region, told me his practice is dealing with a "huge number of additional GP consultations due to patients deteriorating, symptoms worsening and [the] mental health impact of waiting lists".

He added: "That's bad for the patients looking for appointment to be expedited because, unless there's been a clinical change, it's essentially a wasted appointment. But that's also bad for patients presenting with a new illness who can't get a timely appointment."

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