Operationally, the inpatient and outpatient targets actually specify that no more than 10 per cent of inpatients and 5 per cent of outpatients should have waited more than 18 weeks. And for patients waiting for a diagnostic test there is an 'expectation' that no more than 1 per cent should have to wait more than six weeks.
Given concerns that, because of these targets, trusts may choose not to admit patients who have already exceeded the 18-week target wait, the Operating Framework also introduces a new target for patients still waiting. Although the target will not be enforced until 2012/13, the aim is to ensure that no more than 8 per cent of patients on incomplete pathways – those still waiting for an outpatient attendance – will wait longer than 18 weeks. Despite a significant drop in the number still waiting more than 52 weeks immediately following the announcement of this target, the proportion of patients on an incomplete pathway in November 2011, and still waiting longer than 18 weeks, stood at 9.01 per cent. This represents almost 200,000 patients in breach of the proposed target.
There is also clearly some concern by the Department of Health that waiting times may slip over the next few months. In a letter to strategic health authorities on 22 December 2011, David Flory, Deputy NHS Chief Executive, announced additional funding from the existing total NHS budget to improve access (ie, reduce waiting times). A total of £300million will be made available: £50million for each of the four strategic health authority clusters and £100million to clinical commissioning groups via their primary care trust clusters.
The outcome of this funding will not be revealed until the beginning of the 2012/13 financial year, when the waiting times data for February 2011 will be released and we will be able to look back on data from the previous quarter to identify any improving trends in waiting times.
Median waiting times
The latest NHS waiting times data is for November 2011 and includes information on median waits and referral-to-treatment waiting times for inpatients, outpatients and those still waiting.
Median waiting times show the middle point of the waiting time distributions and can be thought of as the 50th percentile; half of patients on the waiting list were treated within this time and half waited longer for treatment.
In November 2011, median waiting times decreased slightly for inpatients (8.1 weeks) and increased slightly for outpatients (4 weeks). Median waits for diagnostics (1.8 weeks) and those still waiting (5.7 weeks) remain stable. This is as expected following previous seasonal trends. All median waiting times are now either similar, or lower, than the median waits in July 2010.
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Median wait in weeks
The 18-week referral-to-treatment waiting times data for November 2011 show a small increase in the percentage of patients waiting longer than 18 weeks for outpatients (3 per cent) and inpatients (9 per cent). Figures for those still waiting (9 per cent) and diagnostics (1.1 per cent) fell slightly compared with October 2011.
However, year-on-year performance is deteriorating for inpatient, outpatient and diagnostic waiting. Despite increases in the proportion of patients having waited longer than 18 weeks compared with November 2010, overall the 18-week operational standard for inpatients and outpatients was met in November.
At 1.1 per cent, the proportion of patients waiting for a diagnostic test is higher than the 2012/13 NHS Operating Framework standard of 1 per cent. However, this is still relatively low and this is the third successive month that the proportion of patients waiting more than six weeks has fallen.
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Percentage still waiting or having waited for more than 18 weeks (more than 6 weeks for diagnosis)