Referral to treatment times in the National Health Service of England: A five-year analysis of the impact of the COVID-19 Pandemic and socioeconomic deprivation and future implications for Ear, Nose and Throat service delivery

INTRODUCTION: Referral-to-Treatment (RTT) waiting times are a critical indicator of healthcare system efficiency and equity. In England, Ear, Nose and Throat (ENT) services are among the most affected, with over half of patients exceeding the 18-week National Health Service (NHS) target. The COVID-19 pandemic exacerbated pre-existing delays and regional disparities. This study evaluates RTT waiting time trends over five years and investigates the influence of socioeconomic deprivation and ethnicity on these patterns. METHODS: Data from the NHS covering August 2019-August 2024 were analysed across regions and Integrated Care Boards (ICBs). Population, ethnicity, and deprivation data were incorporated from governmental datasets. Descriptive and inferential statistics, including Spearman correlation, were used to assess associations between RTT metrics and deprivation, ethnicity, and regional variation. RESULTS: The number of patients on ENT waiting lists doubled nationally, with a 22% patient population increase. The Midlands showed the highest growth in incomplete pathways. Despite short-term improvements post-COVID-19, national RTT compliance and median waiting times worsened. ICB-level data from 2021 onward revealed wide performance variation, but no statistically significant association to deprivation metrics, proportion of ethnic minorities or population differences. Trends in change over time also demonstrated no significant monotonic relationships. DISCUSSION: Despite national evidence linking deprivation and ethnicity to healthcare inequalities, these associations were not observed at ICB level when it comes to median wait times, suggesting potential masking effects of geographic aggregation or unmeasured confounders. New policies promise opportunities for increase in the capacity of service delivery, but further investigations are required to safeguard the equitable access to such services. CONCLUSION: ENT services remain under significant strain, with limited recovery post-pandemic. Community-based NHS care models present new opportunities for ENT's largely non-surgical management pathways.