The backlog of hospital inpatient activity leaving patients untreated and undiagnosed by the NHS continued to grow throughout 2022 to reach 4,092,033 attendances et the end of Q4 2022. Despite promises of increased funding and action plans from the NHS management, the growth in the backlog has not yet even begun to slow down and continues to rise relentlessly.
Furthermore, ambulance waiting times at NHS Accident and Emergency departments are at an all-time high and are a national disgrace leaving emergency patients queuing for hours just to be admitted to the A&E department. The NHS is facing an existential crisis and Governments in Scotland, Westminster and across the UK need to treat this crisis as just as serious as the Covid-19 pandemic that recently swept the country.
It will take a massive injection of resources, cash and human to clear the backlog and return the NHS service to levels that the public deserves and expects.
Hospital Inpatient Spells – Total Activity
Scottish hospital inpatient spells (total for all specialties) were downloaded from the NHS Scotland website and counts for specialties grouped and analysed (see below for details). During the pandemic activity levels fell dramatically as the NHS focussed its efforts on dealing with the influx of severely ill patients affected by Covid-19. For all specialties the average number of spells in the period prior to Covid-19 i.e. from 2017 Q4 to 2020 Q1 was 2,423,038. During 2022 Q2 onwards, in the post-Covid-19 period, inpatient activity quickly increased but has failed by the end of 2022 to return to pre-Covid-19 levels. The average post-Covid-19 activity was 2,051,035 meaning there is on average a quarterly deficit 372,003. The total cumulative deficit of all inpatient spells at the end of 2022 was 4,092,033.
Since the average quarterly activity post-Covid-19 lags the pre-Covid-19 activity, the total backlog in treatments and diagnoses (4,092,033) did not recede during 2022 and will continue to grow during 2023. It is difficult to see how the deficit will be brought down without a significant increase in resources and funding. Even when activity reaches pre-Covid-19 levels, at that stage it will only maintain the backlog at the same level meaning treatment being delayed for everyone. Throughput above the levels achieved pre-Covid-19 are be necessary if the backlog in patients is to be reduced and waiting times reduced.
Spells as a surrogate marker represent one of the best measures of total hospital inpatient activity. Comparison of inpatient spells’ activity for the pre Covid-19, during and post Covid-19 periods provides a unique way of determining what is happening in the NHS. It is influenced by issues such as the cessation of normal in hospital diagnoses and treatment during the Covid-19 pandemic and a reduction of patients consulting their GP during post Covid-19 the pandemic and who have yet to re-enter the system for inpatient treatment and diagnosis. The cumulative deficit of spells is a measure of inpatient activity that has been lost since 2020 Q1 and as a result patients waiting significantly longer for treatment and diagnosis.
As a result of the two-year disruption caused by the Covid-19 pandemic the throughput of inpatients for hospital treatment and diagnosis has dropped causing a backlog of patients to increased massively. The reasons for this is the scale of the disruption caused by the influx of emergency Covid-19 patients; the need for the NHS to mobilise its clinical staff to cope with the influx of emergency patients, many of whom required intensive care support; the disruption of normal services caused by Covid-19 biosecurity practices, and the loss of staff to support emergency patients and staff absences due to Covid-19 isolation requirements. pandemic phase activity was highly depressed because of the need to focus on treating severely ill Covid-19 patients under containment conditions. It is not clear why a return to pre-Covid-19 levels of activity is taking so long.
Note that not all specialties have a backlog of activity and Infectious Diseases, Intensive Care Medicine and Medical Oncology have achieved higher activity post-Covid-19 that prior to the pandemic (see chart Inpatients Cumulative Backlog Individual Specialties, below). For Infectious Diseases, Intensive Care Medicine it is not surprising.
The backlog comprises:
- Patients whose procedures or diagnoses were cancelled or delayed by hospitals
- Patients who had referrals to Outpatient Clinics cancelled or deferred
- Patients not seen by Primary Care because of appointment restrictions or patients’ fear of catching Covid-19 and thus not referred to hospital consultants for treatment/diagnosis.
On this page summary activity data from all specialties were grouped for analysis of the general state of the NHS in Scotland. For individual specialties follow links to each individual page: General Medicine, General Surgery, Trauma and Orthopaedic Surgery, Urology, Gastroenterology, Cardiology, Ophthalmology, Respiratory Medicine, Ear, Nose & Throat (ENT), and Clinical Oncology.
Inpatients Quarterly Activity All Specialties
Inpatients Cumulative Backlog Individual Specialties
Summary Data for all Inpatient Specialties
The table shows for each specialty the backlog of “missing” activity (Backlog Dec2022) at the end of 2022, the average quarterly inpatient activity pre- (preAvg) and post-Covid-19 (postAvg). The data is sorted by the size of the backlog and the first row shows the data for all specialties totalled. The specialties with the highest backlogs (. 200,000) are General Surgery, General Medicine, Trauma and Orthopaedic Surgery, Ear, Nose and Throat, Ophthalmology, Urology and Gastroenterology. A few specialties have achieved increased activity in the period post-Covid-19, most notably, Medical Oncology and Infectious Diseases.
| Specialty | Backlog Dec2022 |
preAvg | postAvg |
|---|---|---|---|
| Total All Specialties |
4,092,033 | 2,423,038 | 2,051,035 |
| General Surgery | 976,250 | 406,858 | 318,108 |
| General Medicine | 741,470 | 732,244 | 664,838 |
| Trauma and Orthopaedic Surgery |
535,611 | 180,801 | 132,109 |
| Ear, Nose & Throat (ENT) |
312,797 | 62,467 | 34,030 |
| Ophthalmology | 256,008 | 88,848 | 65,575 |
| Urology | 225,306 | 121,227 | 100,745 |
| Gastroenterology | 205,686 | 104,263 | 85,565 |
| Geriatric Medicine | 153,573 | 133,396 | 119,435 |
| Plastic Surgery | 140,655 | 43,037 | 30,250 |
| Cardiology | 124,052 | 96,133 | 84,856 |
| Respiratory Medicine | 108,236 | 75,605 | 65,766 |
| Anaesthetics | 98,150 | 24,954 | 16,031 |
| Clinical Oncology | 65,062 | 57,234 | 51,319 |
| Palliative Medicine | 47,762 | 11,371 | 7,029 |
| Neurosurgery | 40,346 | 17,518 | 13,850 |
| Neurology | 33,053 | 19,706 | 16,701 |
| Haematology | 32,129 | 95,723 | 92,802 |
| Rheumatology | 27,014 | 12,442 | 9,986 |
| Cardiothoracic Surgery |
26,046 | 14,047 | 11,679 |
| Renal Medicine | 17,490 | 21,454 | 19,864 |
| Dermatology | 16,640 | 1,930 | 417 |
| Rehabilitation Medicine |
6,999 | 4,775 | 4,138 |
| Allergy | 4,940 | 813 | 364 |
| Immunology | 2,140 | 832 | 638 |
| Clinical Neurophysiology |
850 | 81 | 23 |
| Clinical Genetics | -45 | 0 | 11 |
| Clinical Radiology | -1,318 | 1,669 | 1,789 |
| Endocrinology & Diabetes |
-3,864 | 6,657 | 7,008 |
| Intensive Care Medicine |
-5,503 | 6,633 | 7,134 |
| Infectious Diseases | -21,795 | 15,806 | 17,788 |
| Medical Oncology | -51,729 | 66,510 | 71,212 |
Data and Methods
This analysis uses data published by NHS Scotland showing quarterly activity levels (inpatient spells) across medical specialities and by Health Board:
for raw data see NHS Scotland Public Health
Pre-Covid-19 data was based on data from 2017 Q4 to 2020 Q1
Post-Covid-19 data was based on data from 2020 Q2 to 2022 Q4.
Activity data (hospital speciality spells) from ten specialties were analysed:
- General Medicine,
- General Surgery,
- Trauma and Orthopaedic Surgery,
- Urology,
- Gastroenterology,
- Cardiology,
- Ophthalmology,
- Respiratory Medicine,
- Ear, Nose & Throat (ENT),
- Clinical Oncology.
Spells are used within the NHS to measure hospital inpatient activity and correspond to a period of treatment (medical or surgical) or a period undergoing diagnosis as an inpatient for a patient within a single hospital specialty (e.g. general surgery or say gastroenterology). It should be noted that patient stay may result in more than one spell in hospital. For example, a patient may be admitted as an emergency patient to general medicine followed by transfer to general surgery for a treatment by surgery. Such a patient will have two spells recorded; one in general medicine and one in general surgery. Thus, the numbers provided do not reflect total number of patients hospitalised for treatment or diagnosis as that number will be lower due to the method used to record spells.