Geographic variation in delays for endoscopy and imaging in England since COVID: analysis of monthly diagnostics data
Although diagnostic testing delays in England partially improved post-pandemic, recent progress has stalled or reversed for key endoscopy and MRI services, with substantial and persistent geographic variation and divergent local trends indicating a need for targeted policy interventions.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of a preprint that has not been peer-reviewed. It is not medical advice. Do not make health decisions based on this content. Read full disclaimer
Imagine the NHS diagnostic system in England as a massive, nationwide network of eight different "waiting rooms." In these rooms, patients wait to get important tests like MRI scans, CT scans, or internal camera checks (endoscopies) to see what's wrong with their health.
Before the pandemic, the goal was for almost no one to wait more than six weeks. But when the pandemic hit, the doors slammed shut, and the waiting rooms became incredibly crowded. This study acts like a high-tech surveillance camera, looking at data from January 2019 all the way to April 2026 to see how the crowd has changed.
Here is what the study found, explained simply:
1. The "Recovery" Has Hit a Wall
Think of the post-pandemic period as a long, slow climb up a hill to get back to the top.
- The Good News: Since the peak of the pandemic in 2020, the lines have gotten shorter for most tests. The number of people waiting six weeks or longer has gone down for many scans.
- The Bad News: The climb has stopped. In the last year (comparing April 2025 to April 2026), the lines stopped shrinking and actually started growing again for some specific tests.
- The "Traffic Jam" Tests: The lines got significantly worse for gastroscopy (checking the stomach), colonoscopy (checking the colon), flexible sigmoidoscopy (checking the lower bowel), and MRI scans. For these, the number of people waiting over six weeks jumped noticeably. For example, the wait for an MRI went from about 15% of patients waiting too long to nearly 25%.
2. The "Geographic Lottery"
The study looked at 103 different local areas (like counties or districts) across England. It found that where you live acts like a lottery ticket for how long you might wait.
- The Gap: There is a huge difference between the "best" local areas and the "worst." In some places, the chance of waiting too long is three to five times higher than in other places.
- It's Not Just Luck: The researchers used a special mathematical filter to make sure this wasn't just random noise. They confirmed that these differences are real and persistent.
- The MRI Problem: While the gap stayed roughly the same for most tests, the gap for MRI scans actually got wider. The difference between the best and worst areas is growing.
3. Every Town Has Its Own Story
If you zoom in on individual towns, the story gets even more chaotic. It's not a uniform national trend.
- The Rollercoaster: In some local areas, the waiting times for these tests were cut in half (a huge improvement). In other nearby areas, the waiting times doubled (a huge worsening).
- No Clear Pattern: There isn't a simple rule like "Northern towns are worse than Southern towns." A town might be great at getting you an MRI but terrible at getting you a colonoscopy.
- The "See-Saw" Effect: Interestingly, the study noticed a pattern where areas that were doing very poorly in 2025 tended to improve by 2026, while areas that were doing very well tended to get slightly worse. It's like a see-saw: when one side goes down, the other goes up. This suggests the system might be self-correcting in a chaotic way, or that demand and supply are constantly shifting back and forth.
4. Why Is This Happening?
The paper suggests a few reasons for this "stalled" recovery and the wild differences between towns:
- Supply vs. Demand: There are more people needing tests (demand) than there are machines and staff to do them (supply).
- The "Bottleneck" Effect: Sometimes, a problem in one part of a hospital creates a traffic jam that doesn't clear up even if you add more capacity elsewhere.
- Local Management: Different local areas seem to be managing their queues very differently. Some are solving their problems, while others are letting them get worse.
- Policy Gaps: The study mentions that recent government planning didn't include a specific target to reduce these waiting times, which might have let the problem slide.
The Bottom Line
The study concludes that while England managed to clear some of the massive pandemic backlog, the progress has stalled and even reversed for key tests like stomach checks and MRIs.
More importantly, the system is deeply unequal. Two people with the same symptoms could wait vastly different amounts of time depending on which local area they live in. The authors say that to fix this, policymakers need to do two things:
- Fix the overall national waiting times.
- Figure out why some local areas are doing so much better than others, so the "good" strategies can be copied everywhere.
In short: The lines are still too long, they aren't getting shorter anymore, and where you live makes a huge difference in how long you have to wait.
Drowning in papers in your field?
Get daily digests of the most novel papers matching your research keywords — with technical summaries, in your language.