OBJECTIVES: The Elective Recovery Plan (ERP) was implemented in England in February 2022 to help reduce the number of patients waiting for care accrued since the Covid-19 pandemic. We aimed to a) evaluate the impact of the ERP on waiting times and clinical and geographic inequalities and b) quantify the impact the ERP may have on future waiting lists.

METHODS: Using monthly data published by NHS Digital on all patients referred for elective treatment in England, we estimated the number of patients waiting longer than key NHS waiting time targets since the implementation of the ERP for all specialties, and by gynecology and orthopedic specialties. We used Markov modelling to project NHS waiting list numbers until the end of 2025 for scenarios if the ERP meets its targets or if only 66% of the capacity uplift is achieved.

RESULTS: Since the ERP was implemented, there has been a sharp decrease in two-year waits (42 to 2 per 100,000 people) whilst waits of over 18-months decreased by 29%. Inequalities within the waiting list have widened, with the East of England and the Midlands have the highest waiting list per patient. Gynecology and orthopedic waiting lists had an 18-fold and 13-fold difference between NHS areas with the greatest and smallest waiting lists respectively per patient.

If the ERP achieves its target, the wait list is estimated to peak in March 2023 with 7.3 million patient pathways waiting for care, if only 66% of targeted capacity is met the waiting list will peak at 7.9 million patients in July 2023.

CONCLUSIONS: Despite progress, the waiting list is increasing and geographical and specialty-specific inequalities persist. The NHS must strengthen capacity. Policy makers must recognize the inequalities both regionally and clinically and target resources proportionally to prevent exacerbating inequalities further.