Mapping strategies for reducing inequalities in adult elective surgical care in the United Kingdom: a living scoping review

Health inequalities persist within the National Health Service (NHS), with pre-existing disparities in health outcomes exacerbated by the COVID-19 pandemic. To mitigate further inequality, the NHS seeks to recover its elective backlog inclusively, particularly in surgical care. This review aims to examine interventions, across the elective surgery patient pathway, aimed at mitigating inequalities. Interventions, and their impact on inequalities, are described, while identifying existing knowledge gaps. Online peer-reviewed academic databases and grey literature resources were searched with no time limit set. Articles were screened by two independent reviewers, with data extraction performed by one reviewer and verified by a second. Included articles described interventions successful in, or aiming to, reduce inequalities in elective adult surgery in the United Kingdom with description of the intervention’s impact on patient outcomes. A qualitative content analysis of the primary focus of interventions was performed to identify core themes of intervention. Twenty-two studies were included with interventions predominantly targeting secondary care, particularly orthopaedics. Across the patient pathway, four foci of intervention were identified: patient choice (n = 4); waiting list management (n = 7); treatment accessibility (n = 5), and alternative care delivery models (n = 4). National interventions (n = 11) included patient choice and waiting time initiatives, and increased utilisation of the independent sector, however there were minimal reductions in inequalities. Local interventions (n = 8) showed potential for reducing inequalities, particularly for marginalised groups, through local waiting list initiatives (n = 3) and improving treatment accessibility (n = 5). Specifically designed, targeted interventions seemed effective in addressing inequalities in elective surgery. Several gaps in the literature were evident, however, particularly the effectiveness of interventions in non-orthopaedic specialties and the impact of emerging care models, including surgical hubs, on equality of access and outcomes. This living scoping review is registered with the Open Science Framework (https://osf.io/z3k76). The study protocol was published in advance.