NHS joint replacement waiting lists worsen post-pandemic

Waiting times for hip and knee replacements in England remain far higher than before the pandemic, reflecting decades of under-investment in NHS staff, beds and equipment, according to a study that underlines the task facing the new Labour government.

Other comparable countries have recovered far more quickly, with some at, or even above, pre-pandemic levels of treatment, the research from the Nuffield Trust think-tank found.

It suggested some of these systems had been more resilient to the shock of Covid, not simply because of higher staff and bed numbers, but due to much stronger community support, allowing patients to leave hospital to continue their recovery at home.

Wes Streeting, health secretary, has promised that within five years the vast majority of people will wait no more than 18 weeks to start routine hospital treatment following a referral.

This target has not been met since 2015 and patients are currently waiting for about 7.6mn operations or procedures.

The research, which examined waiting times in 10 high income countries, found England’s hip replacement waits were still 50 per cent longer than before the pandemic.

Nuffield Trust senior fellow Sarah Reed, who led the research, said waits had been going up before the crisis “and then increased massively, and have had a really hard time coming back down”.

Median waiting times for hip replacements jumped from about 87 days before 2020 to 180 days during the first year of the pandemic. For the three subsequent years, median waits remained about 128 days.

Australia, Canada and New Zealand had also been slow to recover the ground lost during Covid. However, other countries had performed much better.

In Spain and Finland, median waiting times for treatment remained essentially unchanged since before the pandemic. In the case of Italy, median waits had actually reduced from pre-pandemic levels.

It was a similar story for knee replacements. Average waits in England rose from about 91 days before 2020 to 209 days in 2020. In the three years since they have remained at about 142 days.

In contrast, post-2020 median waits for knee replacements in Spain, Italy, Portugal and Finland appeared to be similar to, or shorter than, before the pandemic, the research showed.  

However, there was one bright spot. Average waiting times for cataract surgery have improved more quickly in England than nearly everywhere else. These procedures do not generally require an overnight stay, or post-surgery rehabilitation, which are key vulnerabilities in England’s NHS.

Reed suggested the study carried lessons for how the new government should act to increase the resilience of the health system as it grappled with the task of cutting long waits. Increased use of the private sector, backed by Streeting, “doesn’t seem to be an easy win” because about half of hip and knee replacements were already carried out by private providers.

While the government’s commitment to “elective hubs”, which focus exclusively on non-urgent procedures, might increase capacity, she argued “the biggest question mark is . . . about what happens once a patient is discharged from hospital”.

Other countries had far better provision for “step-down care” that supported patients with their rehabilitation at home or in the community, she suggested.

Post-discharge support “will be so key to clearing these backlogs” but it had been “much harder for us to catch up [in England] because, despite years of policy to the contrary, we still do invest more of our resources towards the hospital end of the problem”, Reed added.