Toggle Main Menu Toggle Search

Open Access padlockePrints

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

Lookup NU author(s): Graham Kirkwood, Professor Allyson PollockORCiD



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


© 2022, The Royal Society of Medicine. 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.

Publication metadata

Author(s): Kirkwood G, Pollock AM

Publication type: Article

Publication status: Published

Journal: Journal of the Royal Society of Medicine

Year: 2022

Pages: epub ahead of print

Online publication date: 12/04/2022

Acceptance date: 13/03/2022

Date deposited: 07/07/2022

ISSN (print): 0141-0768

ISSN (electronic): 1758-1095

Publisher: Sage Publications Ltd


DOI: 10.1177/01410768221090672

PubMed id: 35413211


Altmetrics provided by Altmetric