The labour market consequences of extended waiting times for elective inpatient healthcare: an observational study in England using national data

BackgroundWaiting times for elective healthcare in England have increased since 2015/16, when the constitutional standard was last met. However, little is known about the economic consequences of extended waits. We estimated the labour market shortfall induced by above-target waiting times for elective hospital admissions in England over a nine-year period. MethodsCohorts of patients aged 30 to <59 years were identified for 32 treatment specialties using non-emergency inpatient records from NHS hospitals spanning April 2015 to March 2024. Patients were excluded if they had a record within the same treatment specialty from April 2009 to March 2015. Target waiting times were estimated from an exponential distribution with a rate parameter estimated from admissions in 2015/16, assuming patients admitted in each year of the study period remained at their observed percentile of the distribution in that year. Using published trajectories of age-standardised employee pay following elective inpatient treatment, we calculated the additional volume of employment and value of earnings that would be accrued up to five years after the decision to admit, had waiting times remained at target levels. ResultsThe study population comprised 5.4 million patients (mean age 47.0 years, 54.3% female), of whom 27.3% were treated in multiple specialties during the study period. The biggest decreases in the maximum wait when moving from observed to target waiting times were seen in clinical haematology (13.6 months), medical oncology (12.5 months) and clinical oncology (10.1 months). Losses to earnings due to above-target waiting times were greatest for trauma and orthopaedics services ({pound}375 million over five years), general surgery ({pound}368 million) and urology ({pound}229 million). Losses to employment were largest for trauma and orthopaedics (9,228 person-years of employment over five years), general surgery (5,570 person-years) and pain management (2,631 person-years). Across all 32 analysed treatment specialties, the total five-year loss was estimated at {pound}1.5-2.3 billion for earnings and 20,502-33,130 person-years for employment. ConclusionsExtended waiting times for elective inpatient treatment in England are likely to have impacted the labour market. At the macroeconomic level, reducing waits may lead to increased earnings and economic growth, higher tax receipts and reduced welfare expenditure.