Equity in waiting times for two surgical specialties: a case study at a hospital in the North West of England

BACKGROUND: Reducing inequalities in access to the National Health Service is a key government priority. This study investigates the extent to which equitable access is achieved in one routinely administered hospital waiting list system. METHODS: Using hospital episode statistics for one hospital in the North West of England, a retrospective study of waiting times to surgery was undertaken for two surgical specialties (Orthopaedics and Ophthalmology). Participants were 4306 waiting list patients (elective, first episodes) living within Health Authority boundaries, treated within the two specialties between 1 April 2000 and 31 March 2001. Multiple logistic regression analysis of the relationship between waiting times and age, gender, ethnicity and deprivation status was undertaken. Main outcome measures were length of waiting time between being referred to the waiting list and treatment, and odds ratios for being associated with longer than median waiting times by age, gender, ethnicity and deprivation. RESULTS: For ophthalmology, the median waiting time was 140 days. After adjustment, older people had an odds ratio (OR) of 1.64 (95 per cent confidence interval (CI) 1.42-1.89), patients in deprived areas an OR of 1.29 (95 per cent CI 1.08-1.55) and men an OR of 0.79 (95 per cent CI 0.68-0.92) for having longer than median waiting times. No significant association was found between waiting times and ethnicity. For orthopaedics, the median waiting time was 129 days, and there were no significant differences in waiting times according to age, gender, ethnicity or deprivation. CONCLUSION: Routine waiting list systems are not always delivered equitably. For one specialty, female, older and deprived patients were significantly more likely to experience longer than average waits. Potential explanations and implications for policy-makers are considered.