How have waiting times fared under the coalition?

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With election tour buses clocking up the miles and manifestos soon to go to print, the last data on NHS performance measures before the election, released this week, shows us what the incoming government will be inheriting. So what does it tell us?

In brief, in May 2010 the coalition government inherited a waiting list for elective treatment of around 2.6 million patients, with performance standards for both admitted (inpatients) and non-admitted patients (outpatients) being met (the target for those still waiting was yet to be introduced).

By June 2014, however, the total waiting list for elective treatment had increased to 3.14 million, the performance standard for inpatients had been missed for four months out of the previous five, and the proportion of outpatients and patients still waiting for treatment for more than 18 weeks showed an increasing trend.

Concerns over deteriorating performance and rising long waits led the Secretary of State for Health to inject £250 million into the system – and suspend penalties for hospitals who had breached the waiting times target – to help treat some of the longest waiting patients before the year was out.

Further to this, in September 2014, with additional activity not at desired levels, NHS England and Monitor upped the incentive further by agreeing that all additional activity over and above what hospitals had planned to deliver would be paid at 115 per cent of regular tariff.

The effect of this was that by December all waiting time targets were being met, but the number of patients still waiting to begin treatment – the very group the additional activity was meant to be helping – was growing. Indeed, by January this year the NHS was once again breaching the target for inpatients and was very close to breaching the target for outpatients.

In a final push to try to get control of waiting lists before the election, the tripartite of Monitor, the NHS Trust Development Agency and NHS England wrote to trusts at the beginning of February to say that the amnesty for breach penalties would be brought back for the final quarter of 2014/15. The purpose of this was for hospitals to continue to focus on and treat the patients who had been waiting longest.

However, the latest data (February 2015) continues to show mixed results. The percentage of inpatients waiting more than 18 weeks for treatment (13 per cent) is the highest since this target was introduced in 2008, and the percentage (5.3 per cent) of non-admitted patients is the highest for more than six years (see figure below).

On the other hand, the number of patients waiting more than 18 weeks to begin treatment has reduced while more of the patients who were waiting longest were treated than in previous months.

Percentage of patients still waiting/having waited over 18 weeks for treatment

The total size of the waiting list also presents a mixed picture. When the Secretary of State’s initiatives were introduced in June 2014, the total waiting list had risen to 3.14 million patients. In February 2015 this had reduced to 2.93 million; however, this is still high compared to recent years.

Another point to bear in mind is that the number of trusts that report their waiting list data has decreased. When including these non-reporting trusts, NHS England estimated the true size of the waiting list in February 2015 to be around 3.1 million patients.

So the next government to take office in May will find an NHS struggling to maintain its iconic 18-week target. The system continues to be in managed breach, with additional activity charged at 115 per cent of regular tariff with a long total waiting list to boot. This is a disappointing result after a year in which extra money and exhaustive performance management has been devoted to the problem. Special measures to maintain performance on 18 week referral-to-treatment times are beginning to look like business as usual.


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