NHS waiting times: all change?

With health policy announcements coming out almost daily both before and after the election, it’s time to take stock of where we are with NHS waiting times.

First: the good news. Since the turn of the year there have been improvements in performance across all targets, apart from diagnostics.

But, although performance has improved almost across the board, most if not all of this improvement reflects the usual upward swing at this time of year. We will need a month or two more to see if this is sustained.

The Secretary of State’s short-term policy fix of a ‘managed breach’ on waiting times – whereby performance targets were suspended so that hospitals could focus on treating the patients who had waited the longest without being penalised – ran from June 2014 to March 2015 (excluding December 2014).

So was the policy successful? On the one hand, more patients are now waiting longer to receive elective treatment in NHS hospitals than they have done for over a decade. On the other, this policy was not meant to benefit the majority; it was primarily aimed at those patients who had been waiting the longest. There is evidence that the policy has benefited patients who had already had long waits: an additional 25 per cent of admitted patients and 50 per cent of non-admitted patients (those who receive treatment as outpatients) who had waited more than 26 weeks for treatment (the proxy for a long wait) were treated between June 2014 and May 2015 compared to the same period the year before.

So, what are the latest developments?

First, in June, NHS Medical Director Sir Bruce Keogh advised that the referral-to-treatment targets were ‘confusing’ and had created perverse incentives by penalising hospitals for treating patients who had waited more than 18 weeks to begin treatment. He recommended abolishing two of the targets (the percentage of patients treated within 18 weeks as inpatients (the ‘admitted standard’) and as outpatients (the ‘non-admitted standard’)). This would make the percentage of patients still waiting for treatment the sole measure of referral-to-treatment performance.

NHS England accepted his recommendation, and a further one – that financial sanctions for breaching the still-waiting target should be increased. The aim is for the NHS to concentrate on treating all patients (including those who have already been waiting a long time) as quickly as possible.

Although now abolished from the official targets, hospitals are still required to continue gathering data on the admitted and non-admitted figures, so it will be interesting to see how these change over time. Though I agree that focusing on the total waiting time of the whole list is fairer than the previous somewhat contradictory three targets, my concern is that performance against the now defunct admitted and non-admitted targets will deteriorate. We will continue to monitor and publish these figures in our quarterly monitoring reports.

We do need to remember that a well-resourced NHS with a well-managed waiting list and effective planning of hospital services, should be able to manage the waiting list and achieve all three referral-to-treatment targets. The NHS managed to do this between April 2012 and January 2014, but has only done so in two individual months since then.

The other unknown is how long the total waiting list will get to this year. At 3.17 million in May 2015, a figure that rises to 3.4 million when factoring in hospitals that have not reported their numbers, the waiting list looks to be at its longest since February 2008. Ultimately any waiting time target will struggle if the number of people waiting rises relative to our ability to treat them.

In addition, an announcement in June 2015 from NHS England, the NHS Trust Development Authority and Monitor said that non-reporting should only happen in ‘the most exceptional circumstances’ and they are developing an open and honest process to re-start reporting as quickly as possible. If this happens, the size of the recorded waiting list is sure to increase further still.

So it’s a new age for elective waiting times, with a change in how we measure them and how providers are held to account. But there is also lots of uncertainty: how long will the waiting list grow this year? What will happen to performance against the measures that have been dropped? Will all providers who are failing to report waiting times data start reporting? It will be interesting to see what’s next for NHS waiting times – we’ll be following developments and letting you know what we find.

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Comments

#544324 Darren Kilroy
Deputy Medical Director
East Cheshire NHS Trust

In any discussion of waiting times in the NHS, we mustn't lose sight of the assertion that, for almost all clinical scenarios, the powerful and most telling system measure of choice is the time taken to see a senior clinician.

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