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

Syed Ahmar Shah* (Corresponding Author), Rachel H Mulholland, Samantha Wilkinson, Srinivasa Vittal Katikireddi, Jiafeng Pan, Ting Shi, Steven Kerr, Uktarsh Agrawal, Igor Rudan, Colin R Simpson, Sarah J Stock, John Macleod, Josephine-LK Murray, Colin McCowan, Lewis Ritchie, Mark Woolhouse, Aziz Sheikh

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Citations (Scopus)


ObjectivesCOVID-19 has resulted in the greatest disruption to National Health Service (NHS) care in its over 70-year history. Building on our previous work, we assessed the ongoing impact of pandemic-related disruption on provision of emergency and elective hospital-based care across Scotland over the first year of the pandemic.DesignWe undertook interrupted time-series analyses to evaluate the impact of ongoing pandemic-related disruption on hospital NHS care provision at national level and across demographics and clinical specialties spanning the period 29 March 2020–28 March 2021.SettingScotland, UK.ParticipantsPatients receiving hospital care from NHS Scotland.Main outcome measuresWe used the percentage change of accident and emergency attendances, and emergency and planned hospital admissions during the pandemic compared to the average admission rate for equivalent weeks in 2018–2019.ResultsAs restrictions were gradually lifted in Scotland after the first lockdown, hospital-based admissions increased approaching pre-pandemic levels. Subsequent tightening of restrictions in September 2020 were associated with a change in slope of relative weekly admissions rate: –1.98–2.38, –1.58) in accident and emergency attendance, –1.36–1.68, –1.04) in emergency admissions and –2.31–2.95, –1.66) in planned admissions. A similar pattern was seen across sex, socioeconomic status and most age groups, except children (0–14 years) where accident and emergency attendance, and emergency admissions were persistently low over the study period.ConclusionsWe found substantial disruption to urgent and planned inpatient healthcare provision in hospitals across NHS Scotland. There is the need for urgent policy responses to address continuing unmet health needs and to ensure resilience in the context of future pandemics.
Original languageEnglish
Pages (from-to)429 - 438
Number of pages10
JournalJournal of the Royal Society of Medicine
Issue number11
Early online date3 May 2022
Publication statusPublished - 1 Nov 2022

Bibliographical note

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This analysis is part of the Early Pandemic Evaluation and Enhanced Surveillance of COVID-19 (EAVE II) study. EAVE II is funded by the Medical Research Council (MR/R008345/1) with the support of BREATHE – The Health Data Research Hub for Respiratory Health (MC_PC_19004), which is funded through the UK Research and Innovation Industrial Strategy Challenge Fund and delivered through Health Data Research UK. Additional support has been provided through the Scottish Government DG Health and Social Care. SAS and AS are also supported by the COVID-19 Longitudinal Health and Wellbeing National Core Study, funded by the Medical Research Council (MC_PC_20030). SVK acknowledges funding from a NRS Senior Clinical Fellowship (SCAF/15/02), the Medical Research Council (MC_UU_00022/2) and the Scottish Government Chief Scientist Office (SPHSU17). JM is partly funded by the National Institute for Health Research Applied Research Collaboration West (NIHR ARC West).

Data Availability Statement

Data is publicly available on the PHS COVID-19 wider impacts dashboard (


  • population trends
  • public health
  • statistics and research methods


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