The government now needs to broaden its focus from driving down waiting times to ensuring that the NHS delivers equal treatment for patients in equal need of it, according to a new report, The War on Waiting for Hospital Treatment: What has Labour achieved and what challenges remain?, from The King's Fund.
The report argues the government has reasons to feel optimistic that no patient will wait more than 18 weeks from GP appointment to hospital treatment by 2008, although it warns there are many constraints that could still mean the target is missed. It also suggests the government will need to monitor carefully the impact of potentially destabilising policies, such as payment by results and the extension of patient choice.
However, it says that even if the 18-week target is met, it will not be the 'end of waiting' that ministers have claimed. The government should look carefully at the potential costs and benefits of reducing waits even further, it says, and develop policies to remove variations in access to services and unacceptable differences in the quality of clinical practices.
Report author Anthony Harrison said:
'The government is moving in the right direction on waiting times but should use the next two to three years to prepare to go further. Waiting time targets are based on assumptions that are rarely made explicit: namely that the right people are being identified and referred for the right treatment at the right time.
'Yet we know that access to some non-emergency surgical treatments is lower for people from poorer communities compared to those who are better off, and that the clinical criteria by which patients are treated vary from area to area and even doctor to doctor. More work is needed to determine the scale of the current variations, the reasons for them and the policies likely to be effective in tackling them. But as the 18-week target is approached, the government should put much more emphasis on doing just that.'
The government inherited a waiting list of 1.3 million people and a maximum waiting time of 18 months when it came to power in 1997. The War on Waiting for Hospital Treatment, by Anthony Harrison and John Appleby, analyses how the government has reduced this by waging a three-phase campaign against waiting lists and times, and says its policies have become more important and effective at each stage:
- First phase - lasting from 1997 to 2000, the government focused on reducing the number of people waiting through a combination of funds for specific initiatives and advice for NHS trusts
- Second phase - lasting from 2000 to 2004, Ministers set targets in terms of maximum waiting times and introduced a much wider range of policies designed to increase the supply of elective care
- Third phase - starting in 2005, the government set an 18 week 'total' waiting target, including waiting for diagnostic tests, to be met by 2008. Ministers argue that if this is met, waiting for elective treatment will cease to be a major concern for the NHS, and it will be able to turn its attention to other priorities.
The King's Fund chief executive Niall Dickson said:
'The government has waged a war on hospital waiting that has achieved a degree of success few believed was possible at the start. While they may not be perfect, targets can deliver real improvements and Ministers may well feel confident they will meet the ambitious 18-week target. Waiting lists continue to fall and extra capacity purchased from the private sector is starting to come on stream. But nothing should be taken for granted. The sheer number of patients to treat, the worsening financial climate, the uncertain impact of payment by results and choice, and shortages of staff in key areas all present real challenges for the government and the NHS.'
Finally, the report argues that government will need to manage both supply and demand to secure its gains. On the supply side, choice and payment by results could shift work between hospitals and between elective and emergency services, without increasing overall NHS capacity. The government will need to monitor their impact. On the demand side, shorter waiting times could encourage doctors and patients to refer more people into the system. The report says the government needs to look carefully at treatment 'thresholds' to stop this happening and to ensure treatment is clinically appropriate.
Notes to editors:
1. For further information or interviews, please contact the King's Fund media and public relations office on 020 7307 2585, 020 7307 2581 or 07831 554927. An ISDN line is available for interviews on 020 7637 0185.
2. Download The War on Waiting for Hospital Treatment: What has Labour achieved and what challenges remain? by Anthony Harrison and John Appleby. Media can request a free copy by contacting firstname.lastname@example.org
3. John Appleby is chief economist at the King's Fund. John has researched and published widely on many aspects of health service funding, rationing, resource allocation and performance. He previously worked as an economist with the NHS in Birmingham and London, and at the universities of Birmingham and East Anglia as Senior Lecturer in health economics. He is a visiting Professor at the department of economics at City University. John has just finished an independent review of health and social care provision in Northern Ireland.
4. Anthony Harrison is a fellow in Health Policy at the King's Fund. He has published extensively on the future of hospital care in the UK, the private finance initiative and waiting list management, and has recently published a study of publicly funded research and development.
5. The King's Fund is an independent charitable foundation working for better health, especially in London. We carry out research, policy analysis and development activities, working on our own, in partnerships, and through grants. We are a major resource to people working in health, offering leadership and education courses; seminars and workshops; publications; information and library services; and conference and meeting facilities.