This article appears as part of the Inside the NHS newsletter.

Political point-scoring or a reasonable intervention?

Steve Barclay, the UK government's health secretary, has written to his counterparts in Scotland and Wales to say that he would be "open to requests" if they wish to send patients for treatment on NHS England to help clear waiting list backlogs.

Cue a backlash from opponents.

Michael Matheson, Scotland's health secretary, pointed out that Scotland was the only part of the UK to have avoided NHS strikes so far, while a spokesman for the Labour-run Welsh government argued that waiting lists are increasing faster in England than they are in Wales.

So behind the party political rhetoric, is England really performing better on waiting lists?

What are we counting?

When it comes to waiting lists, there are various measures we can use – and they tend to produce different perspectives.

If we stick to comparing Scotland and England only, we could ask how many people in total are currently on NHS lists pending an outpatient appointment or an elective inpatient/day case procedure.

The most recent data for England goes up to the end of June 2023. In Scotland, we only have figures as of the end of March 2023 – the next update will not be published until September 5 – so fully like-for-like comparisons are not currently available.

However, using the data we do have, we can say that there were 7.57 million people on elective waiting lists in England for hospital treatment (including outpatient appointments) by the end of June. This is equivalent to around one in every 7.4 people, but excludes diagnostics such as suspected cancer patients referred for CT scans.

In Scotland, as of the end of March, there were 626,966 people on outpatient and inpatient/day case lists combined – roughly one in every 8.7 people (again, excluding diagnostics)

In Wales approximately one in six people are waiting, but its data automatically includes diagnostics so comparisons are imprecise.

The Herald:

Median waits?

Another way of looking at the issue is the "median" waiting time – the length of time an average patient spends on waiting lists prior to being admitted to hospital for treatment.

The median is the midpoint between the shortest and longest waits, and provides a clearer insight into what is typical.

In Scotland, the median waiting time prior to admission for an inpatient or day case procedure was nine weeks for those patients who were treated between January and March this year (the figures are collated on a quarterly basis). This is almost identical to the 60 day median reported for the same three-month period in 2019.

In England, the median waiting time was 12.3 weeks for patients admitted to hospital in June this year, up from 10.6 weeks in June 2019.

However, it is worth noting that in Scotland the wait time is "adjusted" – meaning that periods where patients were unavailable for treatment have been deducted. In England it is unadjusted, which will account for at least some of the extra wait time.

Long waits


This is where the NHS in Scotland and England really diverge.

Both nations' governments pledged strict timetables to eradicate really long waits, but only England is making serious headway.

As of June this year, there were 314 people waiting for consultant-led treatment in England who had been on NHS lists for more than two years. This had reduced from 3,875 in June 2022. Although England's referral-to-treatment system lumps inpatient, day case and outpatients into a single list, the 314 still waiting after two years were complex cases requiring an inpatient admission.

There were also 7,177 people who had been waiting over 18 months – down from 54,108 in June 2022. This may include some outpatient cases, as well as inpatient/day case waits.

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In Scotland, as of March 2023, there were 6,985 patients still on inpatient/day case lists who had been waiting over two years, down from 10,026 in March 2022.

For 18 month waits, there were still 17,147 patients – an increase from 15,442 in March 2022.

In early 2022, UK Government promised to eliminate two year waits in England by the end of July 2022 and 18-month waits by the end of March 2023.

The Scottish Government followed suit a few months later, pledging to eradicate two year waits "in most specialties" by the end of September 2022, followed by 18 month waits by September 2023.

The difference appears to be that NHS England made tackling the backlogs of very long waits (which affect a comparatively small number of patients) its top priority, while NHS Scotland has chipped away them but focused on getting the median wait back to pre-pandemic levels. 

Neither strategy is objectively "better" than the other, but there are undoubtedly thousands of patients in Scotland in need of operations who have been waiting far too long.

If NHS England can help, it would be unfair to reject it on political grounds.

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