Pledges to reduce waiting times were the centrepiece of Labour's 2005 manifesto. The Labour government had already implemented (and met) targets on waiting times in a number of areas, for example, that patients should not wait longer than four hours for treatment in A&E and should be able to see a GP within 48 hours of making an appointment.
The 2005 manifesto included specific pledges to:
- ensure that no patient would have to wait longer than 18 weeks for a hospital operation from the time they are referred by their GP, with a target average wait of nine to ten weeks
- go further in improving cancer waiting times
- deliver faster test results for cervical smears.
Hospital waiting times
The 18-week target from referral by a GP to a hospital operation was introduced in the NHS Improvement Plan in 2004. It specified that 90 per cent of people referred for treatment needing admission to hospital, and 95 per cent of those receiving treatment without an admission, should start their treatment within 18 weeks of being referred by their GP (this allowed for longer waits for patients who were not medically fit to be treated or who chose to wait longer for treatment). This target has become known as the referral to treatment target (RTT) and is based on the total waiting period from referral, including tests.
This target has been met. According to the most recent figures, 93 per cent of admitted patients and 97 per cent of non-admitted patients were treated within 18 weeks. Only a small number of patients (around 45,000 at November 2009) waited more than 18 weeks for a standard inpatient admission.
Most primary care trusts (PCTs) are meeting the target although there are some variations: 13 of 152 PCTs are currently not achieving the target for admitted patients and two are failing to meet the non-admitted target. There are also some variations between different specialisms at a national level. For example, only 87.7 per cent of patients admitted for trauma and orthopaedic treatment and 86.1 per cent of admitted those admitted for neurosurgery are treated within 18 weeks of referral.
The pledge to ensure an average wait of nine to ten weeks for all patients has also been met. The average (median) waits are now eight weeks for those admitted and five weeks for non-admitted patients (see the Department of Health's Autumn Performance Report 2009).
Historically, this does represent a substantial fall in average waiting times for hospital treatment since 1994, as the median waiting times for inpatient and outpatients show (see figure 1 below). Although the targets for inpatient and outpatient waiting times have been superseded by the 18-week target (designed to address the 'hidden wait' between outpatient and inpatient waiting lists) for the purposes of comparison we show that the average waiting time for inpatient care has fallen from 13.2 weeks in March 1997 to 4.0 weeks in March 2009. The average wait for outpatient care has fallen from 4.8 weeks in March 2005 to 2.4 weeks in March 2009.
Official data on waiting times are based on hospital records. Although not designed for the purpose of measuring waiting times, the NHS national inpatient survey also asks non-emergency patients how long they have been waiting for admission. According to the 2008 results, 55 per cent of patients said they waited two months or less to be admitted, 23 per cent said they waited 3-4 months (both within the 18 week target) but 10 per cent said they waited 5-6 months and 13 per cent said that they waited more than six months. These patients include those who might have had their care delayed for clinical or personal reasons and would be excluded from official records of waiting times.
Cancer waiting times
Reducing waiting times for the diagnosis and treatment of cancer has been a priority since the NHS Cancer Plan was launched in 2000. This established three key targets that have now been met.
In 2007, the Cancer Reform Strategy set out how the 2005 manifesto commitment to go further in improving cancer waiting times would be fulfilled by extending these targets, which have also now been met.
There remain some regional variations in performance. For example, although the two-week target to see a specialist after urgent referral is being met in 94 per cent of cases, the number of patients per 10,000 population referred by GPs onto the two-week pathway varies by as much as three times from one PCT to another (see Cancer Reform Strategy: Achieving local implementation – second annual report). Not all these differences can be explained by variation in need, and there may be differences in how GPs are interpreting and applying the referral guidelines.
The government has recently promised a further extension of the cancer waiting times, with a promise of no more than a one week wait for tests to be conducted and completed.
The government has made a commitment that by the end of 2010 all women undergoing cervical screening tests should receive the results of those tests within two weeks. The most recent available national figures show that there is still some distance to go to meet this target: 21.4 per cent of results were available within two weeks in 2008/9, representing an improvement from 11.1 per cent in 2007/8. There were some regional variations, with rates of availability within two weeks ranging from 38.9 per cent to 8.7 per cent in different PCTs.
In addition to the speed with which test results are available, there are still some variations in the coverage of cervical screening throughout the country. Nationally rates are high, at around 77 per cent in 2007/8, but coverage varies at PCT level from 85.8 per cent to 65.8 per cent. Coverage in London is particularly low; 24 of the 31 London PCTs were in the lowest quartile of PCTs.