What happened to English NHS hospital activity during the COVID-19 pandemic?

The COVID-19 pandemic has had profound effects on healthcare systems around the world, including the UK National Health Service (NHS).

As a result of a reorganisation of services and changes in the care needs and care-seeking behaviour of patients, the use of hospitals in England has changed drastically. However, exactly how much and what type of care has taken place, and the extent to which these patterns vary across different groups of individuals, has not yet been comprehensively documented. Better evidence on this is required to address backlogs in care, and to understand to which groups resources should be particularly targeted after the acute phase of the pandemic is over.

In this briefing note, we use administrative hospital data from across the NHS in England to describe how the use of inpatient (elective and emergency) and outpatient hospital care in 2020 compared with that in the previous year. We first show how overall levels of care changed in the period after the start of the pandemic in March until the end of December 2020 and then examine how changes in activity varied across regions and clinical specialties. We finally examine how these patterns differ across patient age, ethnicity and local area deprivation.

Our findings suggest a complex response to the pandemic driven by large drops in supply for non-COVID services and demand-side responses to the pandemic. They also underline the need to increase available resources to address care backlogs and to direct resources to the people, local areas and groups that have been most affected.

Some key findings were:

  • Between March and December 2020, there were 2.9 million (34.4%) fewer elective (planned) inpatient admissions, 1.2 million (21.4%) fewer non-COVID emergency inpatient admissions, and 17.1 million (21.8%) fewer outpatient appointments compared with the same period in 2019.

  • There was a sharp reduction in hospital activity in March 2020. Although emergency inpatient admissions had almost returned to their 2019 level by August, elective and outpatient volumes remained substantially below their 2019 levels for the rest of 2020. Emergency inpatient admissions began to decline again (relative to 2019) in September.