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The time it takes for a patient to be seen or treated by a particular service or health practitioner is often used, alongside other metrics, as one measure of quality of care. Different teams and organisation across the health and social care sector are responsible for achieving different waiting times targets. However, patient waiting times across those different services often correlate, and improvements to waiting times in one service are often related to, or dependent on, improvements to waiting times in other service.

Waiting times for different services

Commonly measured patient waiting times in the NHS include waiting times to be seen by an ambulance; seen by an A&E clinician; access a diagnostic service; have an elective procedure; or access a cancer treatment. If waiting times for one service deteriorates, it's common for waiting times for other services to also deteriorate. For example, in months where waiting times for ambulances are long, there are often also long waiting times in A&E.

This graphic depicts how longer waits in A&E correlate with longer waits for ambulances

Pressures across the system

One possible reason for this co-ordinated deterioration, is that the whole health and social care system is facing a common pressure. This could be due to a spike in demand for services (eg, Covid-19 infections), a lack of resources (eg, staff shortages) or a disruption to a common service (eg, IT system failures).

During waves of Covid-19 infection a similar pattern of waiting time performance (initial improvement then deterioration) can be seen across multiple different healthcare services

Interdependence between health services

Co-ordinated deterioration in patient waiting times is also caused by the interdependences between different health services. Long waiting times in one part of a patient pathway can have a knock-on effect on the rest of pathway. For example, when social care capacity is full, patients wait longer to be discharged from a hospital bed. When hospital bed capacity is full, patients wait longer in A&E for a hospital bed. When A&E capacity is full, patients wait longer in an ambulance outside of A&E to be ‘handed over’. And when handover times are long, patients in the community wait longer for an ambulance to responds to their 999 calls. This can cause aggregate waiting times across an emergency pathway to rise rapidly.

Average waiting times for patients on an emergency pathway now versus pre-pandemic

Long waiting lists

These interdependences also extend to other hospital services, such as elective procedures, and to waits for other types of care, such as social care and primary care. This means that to reduce one waiting time, other waiting times also need to be taken into consideration. Solutions to long waiting times need to consider patient pathways and health and social care systems as a whole.

Patient waiting times across the the whole health care system increased from 2021 to 2022