NHS Scotland Inpatients Activity

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NHS Scotland: Scotland Inpatients Activity and Backlog

Latest data for Scottish hospital inpatient activity for Scotland up to 31 December 2023 shows a continuation of the post-Covid19 backlog of 1,639,197 patient spells which is the equivalent of 6.2 months worth of activity (Fig 1).  Note that this estimate compares favourably with the NHS published data which states that 840,300 patients are waiting more than one year for outpatient, inpatient or day case treatment – or one of the eight key diagnostic tests (data released 2024-03-31).

During the Covid-19 pandemic hospital inpatient activity levels fell dramatically as the NHS focussed its efforts on dealing with the influx of severely ill patients affected by Covid-19. For Scotland the average number of spells in the quarters prior to Covid-19 (i.e. from 2017 Q1 to 2019 Q4) was 788,143. During 2022 Q2 onwards, when society returned to normal, inpatient activity quickly increased but has failed by the end of 2023 to return to pre-Covid-19 levels (Fig 2).  Thus the total backlog in treatments and diagnoses (1,639,197) is not receding and will continue to grow during 2024. 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.

There are links to pages for individual specialties below.

Figure 1: Inpatients Cumulative Backlog

What it Takes to Reduce Backlog

Throughput above the levels achieved pre-Covid-19 will be necessary if the backlog in patients is to be reduced and waiting times reduced. If quarterly activity returns to the pre-Covid average of 788,143 plus an increase of 10% it will take 63 months (i.e. until 2029-03-31) to clear the backlog. If the activity was increased by 15% that would reduce the time to clear to 42 months (i.e. until 2027-06-30)

Figure 2: Scotland Inpatients Quarterly Activity

Each Specialty Has Different Patient Caseload

The following chart shows a cumulative backlog curve for each specialty.  It is presented to make the point above and a selection of these will be discussed in individual specialty pages:

Figure 3: Inpatients Cumulative Backlog by Discipline

For the following departments follow links:

General Medicine Page
General Surgery Page
Trauma & Orthopaedic Surgery
Urology Page
Gastroenterology Page
Cardiology Page
Cardiothoracic Surgery Page
For other disciplines see Sitemap


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.

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 Q1 to 2020 Q1

Post-Covid-19 data was based on data from 2020 Q2 to 2023 Q4.

Activity data (hospital speciality spells) from most specialties were analysed:

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.

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