Waiting times for elective (non-urgent) treatment: referral to treatment (RTT)

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  • Posted:Thursday 05 August 2021

Waiting times consistently rank as one of the public’s main concerns with the NHS and have a big impact on patient experience of the service. Here we explore how long patients are waiting for treatment and what impact Covid-19 has had on the numbers.

Meeting the RTT standard

The NHS constitution sets a standard that 92 per cent of people waiting for elective (non-urgent) treatment, for example, cataract surgery or a knee replacement, should wait no longer than 18 weeks from their referral to their first treatment. The standard was last met in February 2016, since when performance has declined steadily until the Covid-19 pandemic when it deteriorated rapidly.

To meet the RTT standard 92% of people on the waiting list need to have been waiting less than 18 weeks, but current performance is significantly below that

The number of long waits

In addition to the 18-week standard, to prevent very long waits for treatment, NHS England introduced a policy in 2013/14 that said no one should wait more than 52 weeks from referral to first treatment. The number of people waiting more than a year was maintained at a low level for a long period of time but has never reached zero. Long waits started to creep up again in 2018, and then climbed significantly during the Covid-19 pandemic. Additional data released for April 2021 showed that almost 3,000 people had been waiting more than 2 years (104 weeks) for treatment.

The number of long waits has increased significantly during the Covid-19 pandemic

Specialty RTT performance

Over the past two years all specialities have seen a fall in performance, and none of them are currently meeting the RTT standard. As of April 2021, the largest single waiting list was for trauma and orthopaedics, which had more than 600,000 people waiting for treatment. Trauma and orthopaedics also had the highest proportion of people waiting more than 18 weeks. The impact of long waiting times on patients is not regularly captured, but can mean patients waiting in pain for longer and the possibility of their condition deteriorating.

All specialties have seen a fall in performance against the RTT standard between April 2019 and April 2021

Referrals higher than treatments

In simple terms, the waiting list is growing because people are joining it (being referred) at a faster rate than people are leaving it (being treated). This has led to the elective waiting list growing to its highest level since 2008 with more than five million, or one in eleven, people now waiting for treatment. There are lots of factors that can contribute to this, for example, a growing population leading to more demand, and workforce shortages in the NHS meaning capacity to deliver treatment is limited.

Since April 2016, the number of people joining the RTT waiting list (referrals) has been higher than the number of people leaving it (treatment) in every month except one

Referrals compared to 2019

Covid-19 has had a big impact on elective waiting times. To prioritise hospital capacity for Covid-19 and emergency patients the NHS paused elective (non-urgent) treatment in April 2020 meaning waiting times grew quickly. However, during the national lockdowns fewer people were referred for treatment so the overall number of people on the waiting list remained fairly stable. We don’t yet know if there will be a backlog of people who will seek treatment as restrictions continue to be lifted.

There were almost 6 million fewer referrals on to the RTT waiting list in 2020 than there were in 2019

The King's Fund view

Waiting times consistently rank as one of the public’s main concerns with the NHS and have a big impact on patient experience of the service. The Covid-19 pandemic has caused elective waiting times, and the overall size of the waiting list, to grow substantially; with recent warnings that it could get a lot worse before it gets better. However, the NHS was already missing these key waiting time standards before the pandemic started. It will take considerable time and resources to reduce waits for routine NHS care. Building on the collaboration seen during the pandemic, there is an opportunity to think about how services can be provided in more innovative, more efficient ways that reach those most in need, address health inequalities and can sustainably meet the waiting-time standards, for elective care and more widely across the NHS.

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