Women with Gynaecological Health Problems Face Long Delays for Treatment

The issue of long waits for treatment for women with gynaecological conditions has recently featured in the mainstream media following a report by The Royal College of Obstetricians and Gynaecologists (RCOG).  The report highlighted the huge backlog of 570,000 women in the English NHS system who are waiting for gynaecology appointments for diagnosis and treatment.  The increased waiting times stem from the cessation of routine elective (pre-planned) treatments during the Codid-19 pandemic when only urgent and emergency cases were treated.

The report also highlights the deterioration the the mental health in 80% of women on the waiting lists surveyed by RCOG  often a result of pain they are suffering.  More than three quarters of the women reported that their ability to work has been impaired and or a negative impact in their participation in social events.

Gynaecology Data for the NHS in Scotland

Waiting list data for hospital gynaecology speciality appointments for inpatients procedures and for outpatient appointments in consultant’s clinics are not available.  These have been estimated from actual outpatient appointment data and for the corresponding inpatient episodes and stays data.  Data is available up to the end of Q2-2024. It is unlikely new data will be available before Q3 2025.

Gynaecology Inpatient Activity

Inpatient data represents individual attendances at a hospital where the patient is allocated a bed for the duration of their stay in hospital. These stays also include attendances for the duration of up to one day where the patient is usually discharged during the day and does not stay overnight.  The stays include periods where the patient is hospitalised either for diagnosis of underlying conditions, for treatment of conditions or in some cases both.

Table 1 shows the number of Gynaecology Inpatient stays (Patients column) in Scotland by financial year.  Also shown is the deficit compared to the pre-Covid-19 pandemic (Delta column) and the build up of the deficit (Cumulative column).

Prior to the pandemic yearly inpatient activity had fallen from a peak of 41,630 in 2014/15 to 33,630 in 2018/19.  For the purposes of comparison it is assumed that pre-pandemic activity was  36,810 (average of 2017/18 and 2018/19).  During the peak of the pandemic activity fell to 18,180 and since then there has been year on year increases reaching 27,350 stays during 2023/24 which is still down 9,460 on pre-pandemic activity (See Figure 1).  Using this data it is estimated that 56,480 hospital inpatient stays for treatment and diagnosis have been lost since the Covid-19 outbreak.

What Will it Take to Clear the Estimated Inpatient Backlog

• It will take a 35% increase in the most recent annual activity just to match the pre-pandemic activity.  Achieving this would still leave a perpetual backlog of 56,480 with a waiting time of approximately 18 month to be treated.
• It would take an increase to 47,850 inpatient stays for treatment and or diagnosis to clear the backlog over five years.  This equates to a 30% increase over the pre-pandemic activity level or an unprecedented 75% increase over the most recent yearly activity levels.

It remains to be seen what if anything the Scottish Government and NHS Scotland do about this crisis in women’s healthcare.  Without a massive increase in funding for gynaecology departments women will continue to suffer life changing conditions such as endometriosis, prolapse, fibroids and heavy bleeding.

RCOG Recommendations

“Gynaecologists have raised concerns that the long-term management of pain and symptoms is becoming unsustainable for women and people with these conditions, and is having a negative impact on their quality of life. The consequences for many women has limited their ability to work, to socialise, impacted on their relationships and family life.”

• There needs to be a shift in the way gynaecology is prioritised as a specialty across the health service, including action to move away from using the term ‘benign’ to describe gynaecological conditions.
• Elective recovery must address the unequal growth of gynaecology waiting lists compared to other specialties.
• Elective recovery in gynaecology must focus on reducing the disparities between different regions and CCGs, ending the postcode lottery for gynaecology care.
• Governments across all four nations must put in place fully-funded, long-term plans for the NHS workforce to ensure that staffing does not continue to be a barrier to reducing waiting lists.

Table 1: Inpatient Stays by Financial Year

Figure 1a: Inpatient Activity by Financial Year
Gynaecology Inpatient Stays for treatment and diagnosis by financial year in Scotland

Figure 1b: Inpatient Backlog Since Pandemic by Financial Year
Cumulative increase in the backlog of Gynaecology Inpatient Stays by financial year in Scotland

Gynaecology Outpatients Appointments

Quarterly data is available up to the end of Q2-2024. Outpatients appointments has recovered to reach 90% of the pre-Covid-19 activity.  Table 2 shows the number of Gynaecology Outpatient Appointments in Scotland by financial Quarter.  Also shown is the estimated deficit compared to the pre-Covid-19 pandemic (Delta column) and the build up of the estimated deficit (Cumulative column).

Immediately pre-Covid-19 outpatient appointments were at an average of 46,840 per quarter (mean of 2019Q3 and 2019Q4).  This dropped to 20,040 during the pandemic (2020Q2) and then gradually recovered such that the most recent quarterly data showed 42,520 appointments (2024Q2).  Despite the recovery in outpatient appointments it leaves an estimated backlog of 127,650.

The backlog can be cleared providing:

• An increase of 20% over current activity to 56,200 appointments per quarter (i.e. a level 10% more than immediately pre-Covid-19) would clear the backlog by June 2027.
• A 30% increase to 60,890 appointments per quarter would clear the backlog by June 2026.

Since a number of gynaecology procedures are undertaken in outpatient settings the backlog is delaying access to treatment.  Further, access to treatments requiring inpatients operations, diagnosis and treatments is also delayed.

Table 2: Gynaecology Outpatient Appointments




Figure 1: Gynaecology Outpatient Appointments
Number of Gynaecology Outpatients appointments by financial quarter in Scotland

Figure 2: Outpatient Appointment Cumulative Backlog
Increase in the backlog of Gynaecology Outpatients appointments by financial quarter in Scotland

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Data Sources

Inpatients Data
https://www.opendata.nhs.scot/dataset/annual-inpatient-and-daycase-activity/resource/54613270-bca3-4879-825c-a130c87b7d55

Outpatients Data
https://www.opendata.nhs.scot/dataset/40c82960-c148-4cb8-b780-addddff6e07c/resource/ff1207f8-1f44-4554-94c8-a47625fc3a0d/download/outpatients_by_nhs_board_of_treatment_and_specialty.csv

RCOG
https://rcog.shorthandstories.com/lefttoolong/index.html

https://www.rcog.org.uk/news/more-than-half-a-million-women-face-prolonged-waits-for-gynaecology-care/