Waiting times targets failing the sickest patients

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The King’s Fund is calling on the NHS to ensure that the way waiting time targets are implemented prevents increasing numbers of patients from facing long waits for hospital treatment.

Launched ahead of new figures on A&E performance in February due out later today (Thursday 8 March), the Fund’s latest Quarterly Monitoring Report (QMR) shows that in January, the number of patients waiting for more than four hours after a decision to admit them to hospital from A&E (trolley waits) rose to 81,003, with 1,043 waiting more 12 hours – both the highest on record. These patients are usually waiting for a bed in hospital and are most in need of treatment.

Patients undergoing routine treatment are also facing longer waiting times. The NHS Constitution gives all patients the right to start treatment within 18 weeks of a referral from their GP. But in December 2017 12 per cent of people waited for longer than this – the highest percentage since March 2009. The number of patients waiting more than 52 weeks for treatment increased to 1,750. 

With the four-hour target for A&E and 18-week target for routine treatment looking increasingly unachievable, the Fund says that the way the current targets operate is leaving growing numbers of patients facing long waits for treatment. It is calling on the NHS to ensure that those not treated within the time limits do not experience long delays before they are treated.

The Fund’s regular survey of NHS finance directors underlines recent data highlighting worsening finances among NHS trusts. It also highlights increasing financial difficulties for local commissioners, with more than a third (36 per cent) expecting to overspend their budgets this year, the highest proportion since we began surveying them. This suggests the Department of Health and Social Care may yet struggle to stay within its spending limits, despite the additional NHS funding announced in the Budget. The report also finds that:

  • nearly two-thirds (63 per cent) of finance directors felt that patient care has worsened in their local area in the past year. Just 4 per cent said it had improved
  • more than half (52 per cent) of trust finance directors said they expected their organisation to end 2017/18 in deficit. A third (32 per cent) were fairly or very concerned about meeting financial targets agreed with national NHS bodies
  • demand for services continues to soar – admissions from A&E jumped by 6.8 per cent in January 2018 compared to January 2017, reaching 389,649 
  • more positively, progress on reducing delayed discharges from hospitals has continued to improve, with 145,3180 total days delayed in December 2017, the lowest total since September 2015. 

Richard Murray, Director of Policy at The King’s Fund, said:

'Waiting time targets are failing some of the patients most in need of emergency care. Our latest quarterly monitoring report underlines the heroic efforts of NHS staff to keep care standards high in the face of unprecedented pressure on services. But the way waiting times are designed means that there is very little protection for people who can’t be treated within the initial time limit.

'With demand for services likely to remain high, it’s very unlikely that meeting these targets will become more achievable. The waiting time standards should not be abandoned but the NHS needs to ensure the way they are implemented does not leave patients who are not treated within the time limits facing long waits for treatment.'

Notes to editors

For further information, or to request an interview, please contact the Press and Public Affairs team on 020 7307 2585 (if calling out of hours, please ring 07584 146035).
After publication, the report will be available at: https://www.kingsfund.org.uk/publications/how-nhs-performing-march-2018
The performance related statistics cover the third quarter of 2017/18 (October to December) (although time lags in the publication of some data mean that reporting on some performance indicators covers different periods). 
This report details the results of an online survey of NHS trust finance directors carried out between 8 January and 5 February 2018. We contacted 244 NHS trust finance directors to take part, and 78 responded (32 per cent response rate). The sample included 36 acute trusts; 32 community and mental health trusts; 1 specialist trust; 1 ambulance trust and 8 trusts that were not categorised. In addition, we contacted 149 clinical commissioning group (CCG) finance leads, and 27 responded. Between them these finance leads covered 33 CCGs (16 per cent of all 207 CCGs). 

The King's Fund is an independent charity working to improve health and health care in England. We help to shape policy and practice through research and analysis; develop individuals, teams and organisations; promote understanding of the health and social care system; and bring people together to learn, share knowledge and debate. Our vision is that the best possible health and care is available to all.