ArticleBMJ (Clinical research ed.)2009
Equity, waiting times, and NHS reforms: retrospective study.
Article in BMJ (Clinical research ed.), 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 39 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
39 citing papers in PubMed, 1 synthesis or guideline pooled it, 118 citations in OpenAlex.
- Assessing demographic access to hip replacement surgery in the United Kingdom: a systematic review.International journal for equity in health · 2021Pooled it
- The use of quality information by general practitioners: does it alter choices? A randomized clustered study.BMC family practice · 2013Trial
- Beyond expansion: workforce absence, administration and the persistence of NHS elective backlogs.Journal of the Royal Society of Medicine · 2026Observational
- Mapping strategies for reducing inequalities in adult elective surgical care in the United Kingdom: a living scoping review.BMC health services research · 2026Article
- Comparison of Demographics and Oxford Knee Score in Total Knee Arthroplasty Patients Between the United Kingdom and Saudi Arabia: A Cohort Study.Journal of clinical medicine · 2025Article
- Aggregation Bias and Socioeconomic Gradients in Waiting Time for Hospital Admissions.Health economics · 2025Article
- Trends in incidence and average waiting time for arthroplasty from 1998-2021: an observational study of 282,367 patients from the Scottish arthroplasty project.Annals of the Royal College of Surgeons of England · 2024Observational
- Do Socioeconomic Inequalities Exist Within Ophthalmology and Orthoptics in the UK?: A Scoping Review.The British and Irish orthoptic journal · 2024Article
- The shadows of waiting and care: on discourses of waiting in the history of the British National Health Service.Wellcome open research · 2023Article
- Surgical wait times and socioeconomic status in a public healthcare system: a retrospective analysis.BMC health services research · 2022Article
- The impact of cancellations in waiting times analysis: evidence from scheduled surgeries in the Portuguese NHS.The European journal of health economics : HEPAC : health economics in prevention and care · 2022Article
- Explaining the Gender Gap in Waiting Times for Scheduled Surgery in the Portuguese National Health Service.Portuguese journal of public health · 2021Article
- Implications of Dual Practice on Cataract Surgery Waiting Time and Rescheduling: The Case of Malaysia.Healthcare (Basel, Switzerland) · 2021Article
- Socioeconomic factors affect treatment delivery for patients with low grade glioma: a Swedish population-based study.Journal of neuro-oncology · 2020Article
- An ecological study of NHS funded elective hip arthroplasties in England from 2003/04 to 2012/13.Journal of the Royal Society of Medicine · 2019Article
- Decision making tools for managing waiting times and treatment rates in elective surgery.BMC health services research · 2019Article
- Socioeconomic Status and Waiting Times for Health Services: Current Evidences and Next Area of Research.Health services insights · 2019Article
- Does socioeconomic status affect lengthy wait time in Canada? Evidence from Canadian Community Health Surveys.The European journal of health economics : HEPAC : health economics in prevention and care · 2018Article
- Health Inequalities Associated with Post-Stroke Visual Impairment in the United Kingdom and Ireland: A Systematic Review.Neuro-ophthalmology (Aeolus Press) · 2017Review
- Disparate British Breast Reconstruction Utilization: Is Universal Coverage Sufficient to Ensure Expanded Care?Plastic and reconstructive surgery. Global open · 2016Article
Corrections and comments
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Authors and funding
4 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo determine whether observable changes in waiting times occurred for certain key elective procedures between 1997 and 2007 in the English National Health Service and to analyse the distribution of those changes between socioeconomic groups as an indicator of equity.
designRetrospective study of population-wide, patient level data using ordinary least squares regression to investigate the statistical relation between waiting times and patients' socioeconomic status.
settingEnglish NHS from 1997 to 2007.
participants427,277 patients who had elective knee replacement, 406,253 who had elective hip replacement, and 2,568,318 who had elective cataract repair.
main outcome measuresDays waited from referral for surgery to surgery itself; socioeconomic status based on Carstairs index of deprivation.
resultsMean and median waiting times rose initially and then fell steadily over time. By 2007 variation in waiting times across the population tended to be lower. In 1997 waiting times and deprivation tended to be positively related. By 2007 the relation between deprivation and waiting time was less pronounced, and, in some cases, patients from the most deprived fifth were waiting less time than patients from the most advantaged fifth.
conclusionsBetween 1997 and 2007 waiting times for patients having elective hip replacement, knee replacement, and cataract repair in England went down and the variation in waiting times for those procedures across socioeconomic groups was reduced. Many people feared that the government's NHS reforms would lead to inequity, but inequity with respect to waiting times did not increase; if anything, it decreased. Although proving that the later stages of those reforms, which included patient choice, provider competition, and expanded capacity, was a catalyst for improvements in equity is impossible, the data show that these reforms, at a minimum, did not harm equity.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.