Why are we waiting?

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Waiting times are still low by historical standards (as seen in our Quarterly Monitoring Report), but we are seeing early indications of rising waiting times in some areas of care and for some providers.

Waiting times are important to patients. They are not just a matter of convenience but often have clinical relevance, whether because of the anxiety and psychological impact of waiting, or the pain caused by conditions in need of treatment. In the case of some cancer and heart disease patients, waiting times can be a matter of life and death.

This, combined with the totemic status and success of waiting times targets under the previous government, makes it worth considering why they might be beginning to rise in some places and how the coalition should respond.

One thing that is certainly happening is that financially challenged primary care trusts are capping some elective activity, saying they cannot pay hospitals for more. Other factors may also be at work: without the same tough performance management as under Labour, processes could become sloppier and waits increase because managers have been under less intense pressure. Providers may also find themselves unable to maintain their rate of elective activity if beds are filled with emergency patients as a result of cuts in social or community care.

In its early policy documents the coalition government was opposed to 'top-down process targets', arguing that this form of central command and control could distort clinical priorities. But this stance has clearly changed. The latest command paper, 'The government response to the Future Forum report', placed renewed emphasis on the NHS Constitution with its pledges to deliver the 18-week referral to treatment target for elective treatment as well as for cancer waits.

So what should the government's strategy be?

First of all, it needs to continue to publish data and actively analyse whether and where real problems with waiting times are occurring. But it also needs to be clearer on its response to waiting times rising – how will it enforce the NHS Constitution pledges? Stronger central diktat is unlikely to appeal politically or be particularly effective given the current state of flux of NHS structures. But expecting patients to stand up for their constitutional rights is unlikely to have a major influence either, since effective patient engagement in the constitution still has a very long way to go. Instead, commissioners will need to work with providers to understand and deal with local pressures on waiting times. And if waiting times do start to rise significantly, it could be one of the first and most high-profile tests of who gets the blame when things go wrong in our newly politically independent NHS.


Rich hamilton

Comment date
19 August 2011
A related issue is the loss of grip from the centre in relation to contracts. In many parts of the country soon to be shut commissioning organisations are agreeing deals that are contra the PbR code of conduct, which means the incentives to keep waits short designed into the payment system are no longer effective.

Harry Wood

Comment date
26 September 2011
With experience of two GP practices, GP waiting times seem to have gone up also. It takes several days now to get an appointment when it used to be easy to get one on the same day. Also, it took 4 visits just to get a one-page print out of my son's vaccinations from a medical record -- admin staff seemed to be overworked and only part time. Is GP time being diverted to work on commissioning matters and was the cost of this factored into the so-called savings from removing NHS bureaucracy in PCTs and SHAs? Another issue is where are these savings being reinvested in the NHS -- a government promise. The CCGs don't seem to have enough money to organise themselves properly.

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