Secondary healthcare in the UK — overview, important topics, analysis and stats
A plain-English guide to how secondary care is organised, the pressures it faces, key indicators and recent statistics that matter to decision-makers, clinicians and the public.
What is secondary healthcare?
Secondary healthcare (often called hospital or specialist care) covers consultant-led services delivered after referral from primary care: inpatient and day-case surgery, outpatient appointments, emergency department (A&E) care, diagnostic tests, and specialist community services. It sits between primary care (GPs, pharmacies) and tertiary care (highly specialised regional centres).
How secondary care is organised in the UK
- Providers: Acute hospital trusts, foundation trusts and specialist trusts.
- Commissioning: NHS England and Integrated Care Boards (ICBs) fund and plan services.
- Pathways: Care usually begins with a GP referral or via emergency routes such as A&E or ambulance services.
Key metrics to watch
- Waiting lists and RTT (Referral to Treatment) times
- Hospital activity (admissions, outpatient attendances, diagnostics)
- Workforce numbers and vacancy rates
- Financial pressures and spending
- Quality indicators such as A&E performance, readmissions and patient experience
Recent headline statistics (overview)
Waiting lists: NHS England data from 2024–25 shows around 7 to 7.6 million incomplete RTT pathways, with a significant number of patients waiting more than 52 weeks. This highlights ongoing elective backlogs following the pandemic.
Hospital activity: In 2023–24 there were over 21 million finished consultant episodes in England, reflecting rising hospital activity even as waiting lists remain high.
Workforce and spending: The NHS workforce includes well over a million employees in England. Staff pay accounts for roughly half of the NHS budget, exceeding £80 billion annually. Workforce shortages remain one of the biggest constraints on capacity.
Backlog trends: Analyses from think-tanks indicate that while the system has increased activity, this has not been enough to significantly reduce long waits. Elective lists peaked at nearly 7.8 million in 2023 and have only stabilised or fallen slightly since.
Why the pressure on secondary care persists
- Demand exceeds capacity: An ageing population and more long-term conditions drive increased need for specialist care.
- Workforce gaps: Staff shortages limit how much activity hospitals can deliver.
- Complexity of cases: Longer waits mean patients often present with more advanced or complicated conditions.
- Infrastructure limits: Bed shortages, limited theatre availability and diagnostic bottlenecks slow throughput.
- System inefficiencies: Missed appointments, IT challenges and poor flow between primary and secondary care reduce productivity.
Deeper analysis — what the numbers show
Even with rising hospital activity, backlogs remain large, meaning efforts so far have mainly increased productivity rather than expanded capacity. Clearing long waits requires a combination of workforce expansion, improved patient flow, increased diagnostic capacity, and modernised pathways such as surgical hubs or one-stop clinics.
Financial pressures also play a role. With staff costs and operational demands rising, hospitals face trade-offs. Investment alone is not enough; structural improvements in referral management, perioperative care and community support are also essential.
Priority topics for policymakers and providers
- Workforce retention and long-term staffing plans
- Better waiting list management and transparency
- Expansion of elective recovery initiatives, including surgical hubs
- Greater integration between primary, community and secondary care
- Increased diagnostic and theatre capacity
- Maintaining quality and patient safety during high-demand periods
Implications for clinicians and managers
Operational improvements such as reducing cancellations, improving pre-op assessment, using extended-role practitioners and coordinating regionally across ICBs can help increase throughput. Clear communication with patients about expected waiting times is crucial for maintaining trust.
Limitations of available statistics
Metrics like RTT pathways track administrative processes, meaning one patient may appear multiple times. National averages also hide large regional and speciality differences. For precise insights, the latest NHS England and NHS Digital publications should be consulted.
Conclusion
Secondary care in the UK delivers high volumes of essential treatment but continues to face substantial challenges. Elective backlogs, workforce shortages and financial pressures all contribute to slower progress than desired. Sustainable recovery will require investment, redesign of patient pathways, stronger integration across the system and continual performance monitoring to ensure improvement.
Comments are disabled