Recent trends and geographic variation in delays for endoscopy and imaging in England: analysis of monthly diagnostics data

Background Timely diagnostic testing is essential for rapid diagnosis of potentially life-threatening conditions, but formal assessment of current trends and geographic variation in diagnostic delays in England is lacking. Methods We assessed recent trends in four imaging and four endoscopy tests in England using public data across 103 sub-Integrated Care Boards from 2019 to 2026. We compared the proportion of patients waiting more than 6 weeks in June 2026 versus June 2025 using mixed-effects binomial logistic regression. Changes in geographic variation (beyond that expected by chance) were quantified using random-effect variances. Local trends were examined using conditional estimates. Results Previous reductions in delays have stalled in the past year, even increasing for gastrointestinal endoscopies and MRI. From June 2025 to June 2026, delays increased for gastroscopy (24% to 29%), colonoscopy (26% to 31%), flexible sigmoidoscopy (28% to 32%), and MRI (15% to 23%). Substantial geographic variation persists, with three- to five-fold differences across the middle 50% of local areas. Local variation has increased significantly for MRI. Local trends diverged markedly, with delays falling by >50% in some areas and doubling in others. Conclusions Policy-makers should prioritise tackling deteriorating waiting times for gastrointestinal endoscopies and MRIs, and identifying local drivers of delays.