In the NHS recovery drive, is England outperforming Scotland?

Across the board in the UK, the pace of recovery is slow and any return to “normal” - whether that's characterised as restoring elective activity to pre-pandemic levels, or exceeding them - remains far off.

Many of the objectives set out in Scotland’s ‘NHS Recovery Plan’, first published in August 2021, and England’s ‘Elective Recovery Plan’, published in February 2022, quickly slid from ambitious to unrealistic.

READ MORE: Scot Govt told be 'be more transparent' on missed NHS Recovery targets

There are some areas where England appears to be outperforming Scotland, however.

One is around so-called “long-waiters”.

England’s recovery plan included a goal that, by July 2022, there should be no one left on elective waiting lists who had been waiting for their procedure for more than two years.

According to the IFS, this “has largely been achieved”: between February 2022 and November 2022, the number of patients with two-year waits fell from 23,300 to 1,400 - a reduction of 94 per cent.

By September 2022 there were fewer people on NHS England waiting lists who had been waiting over two years for hospital treatment compared to Scotland (Image: Institute for Fiscal Studies)

The think tank notes that “while the number has not strictly reached zero, this should be viewed as a success for the NHS – it was never likely to completely eliminate these waits, as some of the treatment needed is very complex, and some patients may choose to wait longer.”

A secondary target - to eliminate waits of between 18 months to two years by April 2023 - “remains within reach”, albeit more challenging.

As of November 2022, there were still 47,500 patients in England in this category - up from 45,200 in February 2022.

The total number of people with waits exceeding a year, meanwhile, ballooned by 36%, from 300,000 in February 2022 to 410,000 by November 2022.

In February 2020 - before Covid - that number was just 1,845.

The maths is simple: people are being added to the lists faster than they can be removed, with “little sign” - for now - of the kind of surge in elective activity that would be required to reverse that.

So how does Scotland compare on ‘long-waiters’?

The Scottish Government set out its targets later, in July 2022, with a slower roadmap for inpatient/day case procedures that would see waits over two years eliminated for “most specialties” by the end of September 2022; 18 month waits by the end of September 2023; and year-long waits by the end of September 2024 (in England, this target applies to March 2025).

READ MORE: Private Long Covid clinic 'utterly overwhelmed' as patients told there is 'nothing on the NHS'

On Tuesday, Public Health Scotland will publish its next waiting times statistics showing the position as it stood by the end of December 2022.

However, the most up-to-date information currently available shows that by the end of September last year there were still 7,612 patients on inpatient/day case lists whose waits exceeded 104 weeks (versus 2,200 people in England for the same month).

The number of people whose waits spanned 18 months and two years stood at 9,437 - an increase of 73% on 5,445 at the end of March last year.

It is also notable that number of people in Scotland with 18-month to two year waits as of September last year was around a fifth of the 47,500 patients in the same position in England by November, despite the fact that Scotland has a tenth of the population.

When it comes to the total number of people waiting over a year for hospital procedures on the NHS, however, Scotland looks to be performing proportionately better: 35,337 by the end of September last year, compared to the 410,000 in England by November.

The fact that England seems to be making faster progress on the 18-month and two-year targets may reflect that it set more ambitious timescales for these in the first place, but it also reflects a greater use of the independent sector to help clear backlogs and a faster rollout of elective surgical hubs at a time when Scotland is still waiting for its first National Treatment Centre to open.

READ MORE: Scot Govt says A&E performance is better north of the border - but is that really true?

Both countries are flagging when it comes to efforts to ramp up elective activity to the levels they first envisioned, however.

In Scotland, 2022/23 was supposed to see an additional 27,500 inpatient and day case procedures carried out over and above pre-pandemic averages, rising to an extra 55,500 by 2025/26 - a 20% increase on pre-Covid activity.

In reality, the number of operations which took place on NHS Scotland between April and December last year – 149,836 – was 20% lower than the same nine-month period in 2019.

Yes, Omicron was a factor – but as Audit Scotland noted this week, the Scottish Government “did not undertake detailed and robust modelling to inform the anticipated increases in activity levels set out in the Recovery Plan”.

It is not clear if or when the headline goal of 55,500 extra procedures will be actually achieved, with Audit Scotland observing that a progress report published in October last year contained “no reference to these milestones” and that performance was instead compared against 2021 which “may be confusing when tracking progress against the original ambitions”.

Even in a best case scenario (yellow) NHS England is not expected to return to pre-pandemic levels of elective activity until 2024 under IFS projections (Image: Institute for Fiscal Studies)

In the period from April to December 2022, planned elective activity in Scotland was 20% below pre-pandemic (2019) levels compared to 12% lower from February to November for NHS England (Image: PHS) (Image: PHS)

In England, elective activity is closer to pre-pandemic levels (in February to November last year, its NHS carried out 12% fewer planned operations versus the same period in 2019) but still “clearly lagging behind the planned trajectory”.

The IFS projects that NHS England would have to be carrying out 20.9% more elective procedures by 2024/25 relative to 2019/20 to meet its backlog-clearing targets.

Achieving that would require annual growth in elective treatment volumes of 10.3% over the next two years. Given that the average in the five years prior to the pandemic was just 2.9%, the IFS considers this “highly unlikely”.

But north or south of the border, expect the goalposts to keep moving - and politicians to keep spinning the statistics.