NHS Scotland must treat at least 20% more non-emergency hospital cases over the next three years to eliminate the backlog caused by the COVID-19 pandemic, according to new analysis involving the University of Strathclyde.
The study found that the pandemic exacerbated a struggle to meet demand which had already existed for several years.
The number of referrals awaiting treatment passed 667,000 at the end of December 2023, covering an estimated 10% of the Scottish population.
Without any increase in capacity, researchers calculate the waiting list will rise to nearly one million people by December 2026.
However, treating an additional 32,300 cases per year over the next three years could clear the backlog.
In the early stages of the pandemic, the NHS was forced to postpone elective, or non-urgent, treatments to focus resource on patients who were seriously unwell with COVID-19.
Researchers from Strathclyde, the University of Oxford and lead institution the University of Edinburgh conducted a country-wide analysis of Scotland's healthcare system over an 11-year period, from January 2013 to December 2023, to estimate the extent of disruption and long-term impact.
The study, funded by Health Data Research UK, has been published in The Lancet Regional Health.
Professor Chris Robertson, Professor of Public Health Epidemiology in Strathclyde's Department of Mathematics and Statistics and Head of Statistics at Health Protection Scotland, was a partner in the study. He said: “This study of elective care waiting lists in Scotland is based upon publicly available open data provided by NHS Scotland and uses statistical models to estimate the capacity increase required to clear the backlog.
This investigation shows that the level of investment required to clear the backlog is considerable, amounting to an increase in capacity of 6.67% per year over a three-year period. The challenges faced by NHS Scotland are not unique and reflect broader global trends within healthcare systems.
The waiting list rose from 285,000 in 2013 to 386,000 at the start of the pandemic in 2019 – a 35% increase over six years. This steady rise suggests the service was already gradually declining before the pandemic, according to the study.
The research also found that COVID-19 then intensified the decline. By December 2023, there were 668,000 referrals waiting to receive non-urgent treatment – an increase of 73% over four years. 78,000 of those had been waiting for more than a year, compared with just 3,000 in December 2019.
Longer waits
Backlogs were seen across all health boards in Scotland. By the end of 2023, more than half of inpatient and outpatient referrals in most regions were waiting longer than the Scottish Government's target of 12 weeks.
NHS Borders and NHS Fife were among the worst affected health boards for both inpatient and outpatient referrals, with more than double the number of ongoing cases in 2023 compared with 2019.
Researchers say that comparisons between regions should be interpreted with caution, as the figures do not account for differences in population demographics.
The medical specialties where most patients waited more than 12 weeks for both inpatient and outpatient appointments were ENT (Ear, Nose, and Throat), General Surgery, Gynaecology, Oral and Maxillofacial Surgery and Urology.
Dr Syed Ahmar Shah from the University of Edinburgh’s Usher Institute, who led the study, said: “The NHS's struggle to meet demand didn’t start with the pandemic – it began years earlier. The pandemic accelerated the decline of an already strained system. Recovery efforts so far have fallen short. To turn things around, we need meaningful collaboration between the government and NHS leadership to set realistic recovery plans and ensure adequate funding for their implementation.
“Addressing the current challenges will require a significant and sustained increase in hospital capacity for elective care over several years to tackle the backlog. Long-term recovery also demands a holistic approach, including system-wide strategies like better demand management, prioritising cases by clinical urgency and improving overall efficiency.”