Slow progress on tackling hospital waiting lists more fairly, despite the government’s promise to ‘build back better’ says new King's Fund report

People from more deprived areas are more likely to have long waits for planned hospital care in England than people from less deprived areas, finds a new report from The King’s Fund. In a new report, the health and care think tank warns that these inequalities could become further entrenched unless the government makes a firmer commitment to taking a more ‘inclusive approach’ to tackling hospital waiting lists. 

The report finds that while some local NHS organisations have made progress in understanding the unequal experiences of people waiting for planned hospital care, others are yet to take this first step. More broadly, the researchers found there had been limited concrete action to address inequalities in access to planned care.

Following the first wave of the Covid-19 pandemic, NHS England asked local NHS organisations to take a more ‘inclusive approach’ to recovering planned hospital services, such as knee or hip replacements. This was intended to improve how hospitals managed their waiting lists by understanding if and why groups of people – including people from minority ethnic groups – were systematically waiting longer for care, and taking action to address those inequalities. 

However, The King’s Fund’s report which was funded by the Health Foundation, based on evidence gathered from three in-depth case studies and a review of board reports from 13 NHS trusts and 13 integrated care boards, suggests inclusive recovery is not yet embedded within NHS organisations. The authors conclude that this is for a range of reasons, including a lack of analytical resources, the need to better engage clinicians and other staff in the rationale for new approaches, and NHS organisations not being held to account for this work. The authors also found that, critically, there has been a lack of a clear vision from national leaders as to why inclusive recovery is important for delivering better and fairer services for patients and the public. The report calls on the government to pay greater attention to inclusive recovery to ensure progress is made so that people can be treated fairly, no matter their background. 

Ruth Robertson, Senior Fellow at The King’s Fund, said: 

‘Our research shows there is considerable variation in how local NHS organisations are interpreting and implementing the call to action made in 2020 to tackle hospital waiting lists more inclusively. In some respects, this is a good thing – what works in one location wouldn’t necessarily work for another’s population. And there are already some examples of how services for patients can be improved, including changes that make appointments easier to access and the use of AI to target support for patient groups who could benefit most from additional guidance and support while they wait for their hospital treatment.

‘It is possible for the NHS to tackle long waits for care and to do this in a way that doesn’t widen the already shameful inequalities that have plagued the NHS in England for decades. But to help realise this ambition and make good on its promise to ‘build back better’ after the pandemic, the government must now provide greater emphasis and clarity on how it expects waiting lists to be tackled more fairly. An inclusive approach should be embedded at the heart of any future plans for elective recovery. 

‘In the years to come, when we judge how well the NHS dealt with recovering waiting lists in the aftermath of the Covid-19 pandemic, we should look at whether and how health inequalities were addressed. Addressing inequalities in the backlog is good for patients, good for communities and good for the NHS.’ 

ENDS 

Notes to editors

1. Read the report: Tackling health inequalities on NHS waiting lists

2. The work for this project was funded by The Health Foundation. This output was independently developed, researched and written by The King’s Fund.

3. The report is based on three case studies and interviews with people involved in the development and use of AI to support people on waiting lists (39 interviews in all) conducted between December 2022 and June 2023, review of board papers from 13 trusts and 13 ICBs conducted in November 2022 and a review of literature and national referral to treatment times data.

4. There are also well-publicised examples across the country of how trusts and ICBs are taking an ‘inclusive approach’ to elective recovery. The report outlines some of these, including Cheshire and Merseyside Integrated Care System using AI to target prehabilitation support to people at highest risk of poor health outcomes from their treatment, and University Hospitals of Leicester NHS Trust identifying inequalities in ‘do not attend’ appointment rates linked to deprivation and other factors and offering extra support to people to help them attend. See pages 23-24 of the report for further examples.