How long you wait for treatment in the NHS has become something of a lottery, varying significantly depending on the type of treatment and location. These discrepancies can often affect patient outcomes and population health.

"Tackling the backlog of patient waiting lists is a key component of the government and NHS’s ongoing strategy to improve patient care and ensure timely treatment. At Graphnet, we recognise the importance of supporting NHS trusts in meeting these targets,” said Markus Bolton, Director, Graphnet.

We’ve dug into the NHS’s Referral to Treatment Waiting Times Data 2024-25[1] (Oct 2024 figures) to explore why disparities exist, where the biggest gaps are, and what can be done to address them.

Urban areas hit hardest by COVID-19 Pandemic

Waiting times in rural, urban, and mixed areas may seem similar, but a closer look at the data reveals some significant disparities. Much of this has been made worse by COVID.

 

Hospitals in cities and urban areas often diverted resources to emergency COVID-19 care, delaying elective treatments like hip replacements, cancer screenings, and mental health support, according to reports.

On top of this, elective surgeries were cancelled or postponed at higher rates in urban areas to prioritize COVID-19 treatment.

Cancer referrals and diagnostics fell drastically, leading to later-stage diagnoses and worse patient outcomes. And routine GP appointments were harder to access, particularly in deprived urban areas, worsening long-term health conditions.

NHS staff in cities like London and Manchester faced high rates of sickness and burnout, reducing hospital capacity. This has had a knock-on effect of healthcare workers actually leaving the profession or moving to less stressful regions, further impacting staffing levels in urban ICSs.

Since Covid, recruitment efforts have struggled, especially in areas with high living costs like Central London.

Regional differences and the role of ICSs

Integrated Care Systems (ICSs) were established in the UK in 2022 to help reduce regional disparities in healthcare services. While there has been progress, they are fighting against entrenched historical inequalities. This is highlighted by the fact that Sub-ICB Locations – or SICBLs - within the same ICS exhibit extreme variation in waiting times.

Many SICBLs have been historically underfunded, and national policies have not addressed this imbalance to date.

If we look at waiting times by wider region, the discrepancies and gaps starting to appear more prominent.

The time by which 92 out of 100 patients have been treated varies, ranging from 40.2 weeks in the East of England to 34.6 weeks in the Northeast and Yorkshire – a difference of 4.4 weeks.

 

The pandemic has exacerbated existing regional disparities, with some regions experiencing more severe impacts on healthcare services. For instance, the North East faced significant challenges during the pandemic, which may have contributed to longer waiting times in that region.

General deprivation levels are also impacting waiting times. Areas with higher deprivation and older populations tend to experience greater demand for NHS services, leading to longer waiting times.

This translates to top-performing NHS area seeing 160 more patients per month than the worst-performing area, according to both the Hewitt Review in 2023[2] and the Ration Watch 2024 report[3].

Currently, there are no formal NHS England-wide structures for best practice sharing between ICBs or any form of national oversight ensuring equal performance across different regions.

Informal sharing networks do exist, but struggling regions do not seem to benefit from the practices of better-performing areas. Data sharing and best practice adoption are inconsistent, limiting improvements in reducing waiting times.

As it stands, NHS England sets national targets. However, ICSs lack flexibility to address regional challenges effectively, and short-term budget cycles prevent ICSs from making long-term investments in capacity building, further impacting waiting times.

 

Waiting times by treatment type

When we look at treatment type figures there are a number of caveats. For example, some treatment centres are concentrated in densely populated areas, while certain treatments inherently require more time. Technological resources and infrastructure capabilities also influence waiting times, with serious conditions being prioritised.

This explains why Ear, Nose and Throat services have the longest wait in weeks (43.2) and elderly medicine (21.7) the shortest wait.

Treatment sought	In what proportion had the patient been waiting within 18 weeks?	How many weeks majority of patient had been waiting less than
Ear Nose and Throat Service	52.0%	43.2
Oral Surgery Service	53.8%	42.9
Trauma and Orthopaedic Service	57.5%	42.4
General Surgery Service	59.2%	42.3
Gynaecology Service	57.5%	41.8
Plastic Surgery Service	61.4%	41.4
Neurosurgical Service	59.1%	39.9
Urology Service	60.7%	39.9
Total	62.4%	39.0
Neurology Service	59.5%	38.6
Other - Surgical Services	65.0%	38.5
Dermatology Service	62.4%	37.8
Cardiology Service	63.3%	36.3
Other - Paediatric Services	65.2%	36.2
Ophthalmology Service	67.1%	35.4
Gastroenterology Service	66.0%	35.3
Other - Medical Services	68.3%	34.9
Respiratory Medicine Service	66.2%	34.0
Cardiothoracic Surgery Service	72.4%	32.6
Other - Other Services	74.6%	31.3
Rheumatology Service	71.7%	30.3
General Internal Medicine Service	77.4%	27.5
Other - Mental Health Services	83.6%	22.7
Elderly Medicine Service	85.7%	21.7

 

A lack of investment in prevention and early intervention leads to higher emergency admissions, increasing waiting lists. Regions with better primary care and social care integration have shorter waiting times, but many ICSs fail to prioritize preventative healthcare.

We do find that there is a rural / urban split for some treatment types. For example:

·        Other - Mental Health Services has a 47% difference in weeks waited between urban (24.7 weeks) and rural (12.9 weeks) locations.

·        Cardiothoracic Surgery Service has a 17.9% difference between rural (39.8 weeks) and urban (32.7 weeks).

·        Other - Surgical Services has an 8.1% gap between urban (39.1 weeks) and rural (36 weeks).

NHS resources are often allocated to urgent and emergency care, leaving elective procedures deprioritised, especially in underperforming ICSs.

During the pandemic, elective surgeries were postponed, creating a massive backlog that disproportionately affected lower-performing ICSs, which lacked the infrastructure to recover quickly.

Add to that a nationwide shortage of anaesthetists, surgeons, and theatre nurses[4] - with some ICSs having more critical shortages than others – and you get longer waiting times in under-resourced areas.

High-performing ICSs also tend to have more surgical theatres and better scheduling efficiency, whereas low-performing ICSs struggle with limited operating space, leading to longer queues. Rural areas may also have fewer hospitals offering elective surgeries, requiring longer travel times and limited appointment slots.

Some ICSs also invest more in cancer screening, while others have lower screening uptake due to lack of funding, patient awareness, or accessibility. Meanwhile, access to oncologists, radiologists, and diagnostic specialists is unevenly distributed, with London and other major cities having more expertise than rural or deprived areas.

Delays in scans, biopsies, and lab tests (due to lack of imaging machines, radiologists, or administrative inefficiencies) may also mean early-stage cancers are not detected in time.

Solutions in Action

Waiting lists are an issue that all NHS trusts are working hard to resolve. Graphnet is working with a number of trusts to tackle this issue, whether looking for a left shift in medicine towards prevention or addressing bed blocking concerns.

The one impact of Covid that has helped reduce waiting times is the rise in virtual appointments. GP telephone appointments and the more than 12,000 virtual ward beds has helped.

Markus Bolton, Director, Graphnet added: “Our Elective Recovery Tool plays a critical role by streamlining waiting list management, helping trusts prioritise and optimise patient pathways.

“By automating data validation, reducing administrative burden, and enhancing patient communication, we are not only helping trusts recover from the backlog, but also ensuring that patients receive the care they need when they need it."

·        Population Health Management: Using rich and accurate patient data, our Combined Insights for Population Health Action (CIPHA) solution works as both a preventative and proactive care measure. This could be through early intervention to prevent cases escalating and being added to the waiting lists, or through proactive management of those already on the lists.

·        Elective Recovery: The proactive element of CIPHA is managed through our Elective Recovery platform that allows users to identify deceased patients still on lists, remove duplicate entries and recognise when someone is surgically fit.

Frimley Health Foundation Trust uses shared care records overlaid with our population health management to, as Nigel Foster, Director of Finance, said: “Bring our waiting lists and the people on them to life”. 

Data on ethnicity, deprivation, frailty, dependency and resource usage can be interrogated to look at the proportion of people on every waiting list and segment them into groups with a view to targeting interventions.