Socioeconomic inequality, waiting time initiatives and austerity in Scotland: an interrupted time series analysis of elective hip and knee replacements and arthroscopies. (October 2022)

• Record Type: Journal Article
• Authors: Kirkwood, Graham; Pollock, Allyson M
• Is Part Of: Journal of the Royal Society of Medicine. Volume 115:Number 10(2022)
• Page Start: 399
• Page End: 407
• Publication Date: 2022-10
• Subjects: NHS -- health policy -- inequalities; Medicine -- Periodicals; Medicine -- Great Britain -- Periodicals; Periodicals; 610.5
• DOI: 10.1177/01410768221090672
• Languages: English
• ISSNs: 0410-0768

Abstract

Objectives: National Health Service (NHS) waiting times have long been a political priority in Scotland. In 2002, the Scottish government launched a programme of investment and reform to reduce waiting times. The effect on waiting time inequality is unknown as is the impact of subsequent austerity measures. Design: An interrupted time series analysis between the most and least socioeconomically deprived population quintiles since the introduction of waiting time initiative 1 July 2002 and austerity measures 1 April 2010. Setting: All NHS-funded elective primary hip replacement, primary knee replacement and arthroscopy patient data in Scotland from 1 April 1997 to 31 March 2019. Participants: NHS Scotland funded patients treated in Scotland. Main outcome measures: Trends and changes in mean waiting time. Results: There were 135, 176, 122, 883 and 173, 976 NHS funded hip replacement, knee replacement and arthroscopy patients, respectively, in Scotland between 1 April 1997 and 31 March 2019. From 1 July 2002 to 31 March 2010, waiting time inequality between the most and least deprived patients fell and increased thereafter. For hip replacements before 1 July 2002, waiting time inequality increased 1.07 days per quarter; this changed at 1 July 2002 with significant slope change of −2.32 (−3.53, −1.12) days resulting in a decreasing rate of inequality of −1.26 days per quarter. On 1 April 2010 the slope changed significantly by 1.84 (0.90, 2.78) days restoring increasing inequality at 0.58 days per quarter. Knee replacements and arthroscopies had similar results. Conclusions: The waiting time initiative in Scotland is associated with a reduction in waiting time inequality benefiting the most socioeconomically deprived patients. Austerity measures may be reversing these gains.