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Impact on emergency and elective hospital-based care in Scotland over the first year of the pandemic

May 2022: Research published in the Journal of the Royal Society of Medicine looks at how the COVID-19 pandemic disrupted healthcare in Scotland from March 2020 to March 2021.

Impact on emergency and elective hospital-based care in Scotland over the first 12 months of the pandemic: interrupted time-series analysis of national lockdowns

Shah, S.A.; Mulholland, R.H.; Wilkinson, S.; Sheikh, A.; et.al.

Journal of the Royal Society of Medicine

Published 03 May 2022

Available via: https://journals.sagepub.com/doi/10.1177/01410768221095239 

Plain English Summary 

On 11 March 2020 the World Health Organization (WHO) declared a global pandemic of coronavirus (SARS-CoV-2). The UK Government announced a nationwide lockdown on 23 March.

The resulting waves of the pandemic, including different variants, created the biggest disruption to National Health Service (NHS) care in its 70-year history.

Epidemic v pandemic: what’s the difference? [BBC News Video]

In Scotland, the first lockdown was followed by phases of national and regional restrictions:

  • 29 May 2020: Phase 1, 19 June 2020: Phase 2, 10 July 2020: Phase 3
  • 22 September 2020: ‘Circuit breaker’ in response to rising cases
  • 02 November 2020: Local authority restrictions based on regional infection levels
  • 26 December 2020: Second UK-wide lockdown
  • 02 April 2021: ‘Stay at home’ rules ease to ‘stay local’.

Why did we carry out this work?

We showed previously that in the first three months of the COVID-19 pandemic, there was a dramatic drop in Accident and Emergency (A&E) attendance and emergency hospital admissions, as well as planned hospital admissions. Emergency admissions started to rise again by June 2020.

Read about our earlier work on hospital care disruption

We wanted to look at the impact of relaxing and tightening restrictions on hospital-based care over the first year of the pandemic. This includes looking at particular services and groups of people.

This information provides a clearer picture of which areas of hospital-based care need the most attention. It may also help policy-makers and healthcare staff to prepare for potential future pandemics.

What data did we use?

We used data from the Public Health Scotland (PHS) ‘R Shiny app: Wider impacts of COVID-19’. These data are available to the public, as there is no information on individual people.

Visit the ‘Wider impacts of COVID-19’ app [PHS Dashboard]

We studied data from two time periods:

  • 22 March 2020 to 27 September 2020
  • 28 September to 28 March 2021.

We looked at A&E attendance, and planned and emergency hospital admissions. We considered the results in terms of a person’s age, sex and where they live, as well as looking at specific areas of care. These include cancer care, cardiology, gynaecology, surgery and care for young people (paediatrics).

We compared care in 2020-2021 with 2018-2019, by looking at the average admissions over four-week periods, at different points in the year.

What did we find?

Overall pattern

The drop in cases seen just before the first UK lockdown was followed by a slow recovery between April and September 2020. The number of people attending hospital decreased again when restrictions were reintroduced at this point. This was the case until the end of the study in March 2021. Despite some recovery in the summer of 2020, hospital activity remained well below the levels seen in previous years.

Different groups

Over the course of the study, we did not find any significant changes in hospital admissions between men and women, or people living in more or less deprived areas.

However, hospital admissions did vary by age. Children under 5 were the most impacted by the first lockdown. This group continued to have the lowest use of emergency hospital services in 2020-2021 compared to 2018-2019. The overall drop in emergency care admissions seen in September 2020 was the most dramatic in children aged 5-14.

Specialist care

Emergency admissions in cancer care, cardiology, A&E and child surgery all recovered to similar levels seen before the pandemic by the end of the study.

Planned cancer care, and care for children, did recover to pre-pandemic levels by the end of the study. However, we found that planned hospital admissions for other specialities decreased during September 2020 and stayed at lower levels for the remainder of the study period.

Why is this important?

This is the first study to look at the impact of the pandemic on hospital care for a national population over a longer period of time.

In this research, we have showed that NHS hospitals in Scotland continued to face significant disruptions to care throughout the first year of the COVID-19 pandemic. This particularly affected emergency care for children, and planned surgeries and gynaecological care.

There are many reasons why hospital admissions may have decreased, and continued to remain lower than in previous years. This includes people worrying about contracting COVID-19 in hospital or overburdening NHS services. Disruptions to primary care referrals, cancellation of routine or planned treatments, and lower numbers of seasonal illnesses or transport accidents due to home working may also have led to the reductions observed.  

Further research is needed to understand the causes of lower levels of hospital attendance, so that policy-makers, healthcare staff and the public can take steps to reduce avoidable illness and death.


This plain English summary was created with the support and feedback of the EAVE II Public Advisory Group (PAG). 

To learn more about the PAG, see: Our EAVE II Public Advisory Group (PAG) | The University of Edinburgh