387,152 patients still waiting over a year for treatment
The government has today announced another increase in the number of patients who have been treated within the 18-week target from referral to treatment (RTT). The latest count, from October 2007, shows 59.9 per cent received treatment within the targeted time.
But this conceals the very serious problems that remain:
- 713,513 (or 18.1 per cent) of elective patients still waiting for treatment have been waiting longer than 36 weeks, with 387,152 (9.8 per cent) of these having waited over a year.
- There is a massive postcode lottery. Just 33 per cent of patients treated in October 2007 in Hastings and Rother Primary Care Trust (PCT) were treated within 18 weeks, compared with 82 per cent in Blackpool PCT and Telford & Wrekin PCT.
The national picture
Performance has been steadily improving: in January 2007, only 47 per cent of admitted patients were making it through the pathway within 18 weeks; in April it was 51 per cent; in June it was 54 per cent and in September it was 57.1 per cent. Now it stands at 59.1 per cent.
However, current rates of improvement will not be enough to meet the target that 100 per cent of patients be treated within 18 weeks by December 2008.
The improvement between September and October is consistent with the linear trend identified in the recent report Why are we waiting?, released by the independent social policy think tank Civitas earlier this month. On this basis, only 77 per cent of admitted patients will be treated within 18 weeks by December. The interim benchmark of 85 per cent by March looks simply utopian and, perhaps unsurprisingly, the government recently revised the December 2008 target down to 90 per cent:
Percentage of patients treated within 18 weeks of referral, England, January-October 2007 and projected improvement up to December 2008
Source: Gubb, J, Why are we waiting?, London:Civitas, December 2007 (calculations by author)
More difficult still
While it’s true improvement may accelerate over time – as more trusts get the data right, referral management centres become more effective and more care pathways have been redesigned – it is equally possible that the problem will be revealed as more intractable than it appears. In many cases meeting the 18 week target will involve much more than just marginal improvements.
Very long waits
A closer look at the Department of Health’s RTT statistics released today shows many patients are still waiting a very long time.
For admitted patients who received treatment (whose ‘RTT clock’ stopped) in October 2007:
- 21,086 (or 8.0 per cent of patients where data is recorded) had still waited over a year for treatment; while 37,302 (14.0 per cent) had still waited over 36 weeks.
These are higher numbers than in September, where the figures were 19,441 and 33,665 respectively.
- Only 38 per cent receiving trauma and orthopaedic care were treated within 18 weeks, yet is in the highest demand of all electives.
- For 16.3 per cent of patients, data is still not available. We do not know how long they waited.
For patients who were still waiting for treatment as of October 2007:
- Just 59.3 per cent are projected to be treated within 18 weeks of referral (less than the 59.9 per cent of those treated in October).
- 713,513 (or 18.1 per cent) have currently been waiting longer than 36 weeks and 387,152 (9.8 per cent) have currently been waiting over a year.
The figure for 36 weeks is substantially larger than that for September when 665,895 (or 16.7 per cent) of patients waiting had been doing so for longer than this time.
Despite only being one part of the pathway, 30, 832 were still waiting over 26 weeks just to receive diagnostics, of which 16,551 had been waiting over a year.
Many of these are in particular PCTs; for example 97.1 per cent of audiology patients in Herefordshire PCT waited longer than 13 weeks, compared with none in Worcestershire PCT , despite the fact that Worcestershire PCT diagnosed over four times as many (4,771 compared with 1,153).
Massive variation in performance
While reaching the RTT target appears imminently possible for some NHS organisations, many still have a very long way to go. A patient’s chances of getting treated within 18 weeks still depend far too much on where they live.
The DH statistics for those treated in October 2007 shows the true extent of this. The best and worst performers were:
- Just 44 per cent of elective referrals treated within 18 weeks in South East Coast Strategic Health Authority (SHA), compared with 69 per cent in West Midlands SHA;
- Just 33 per cent of elective referrals treated within 18 weeks in Hastings and Rother Primary Care Trust (PCT) compared with 82 per cent in Blackpool PCT and Telford & Wrekin PCT;
- Just 26 per cent of elective referrals treated within 18 weeks at Barking, Havering & Dagenham NHS Trust compared with 90 per cent in Yeovil District Hospitals NHS Foundation Trust;
- Just 21 per cent of referrals for neurology treated within 18 weeks in South East Coast SHA, compared with 86 per cent in East Midlands SHA.
These figures clearly show that, while we should not underestimate the scale of the achievement thus far, we definitely shouldn’t be underestimating the scale of the challenge ahead, nor the political pressure on NHS organisations to meet it.
A better approach
The uniform 18-week target should be scrapped. As of April 2008, patients will be able to choose where to have elective treatment between all willing providers, including the independent sector that can meet the NHS tariff.
RTT waiting times for providers should be included in the information patients have when making this choice. Patients could then decide how important waiting is to them, weighed against other measures such as quality of care, length of stay, health outcomes and how far they are prepared to travel.
As former PM Tony Blair himself acknowledged in September 2005: ‘We only got big falls in waiting times after introducing competition for routine surgery. Fact.’
James Gubb, Director of the Health Unit at Civitas said: ‘Instead of political targets, performance should be driven by choice and competition – a self-sustaining and much more positive mechanism for change.
‘If this means more patients choosing to have their treatment in the independent sector or the better NHS hospitals, then these should be allowed to expand in response. As is the case elsewhere, it is the ability of patients to compliment, complain and ultimately take their business elsewhere that will drive providers in the NHS to improve.
‘GPs must be in the driving seat, offering patients real choice and ensuring this mechanism is available.’
Notes to authors:
- i. The Referral to Treatment (RTT) waiting time target was introduced with the NHS Improvement Plan in 2004. It initially required that all patients be treated within 18 weeks of GP referral by December 2008, but this was revised to 90 per cent in the NHS Operating Framework for 2008/09 (released in December 2007).
- ii. GPs currently seem something of an obstacle to patient choice driving improvement. The number of patients who recalled being offered a choice of hospital for their first outpatient appointment actually fell by five per cent between March and July 2007 to a very low 43 per cent; and just 45 per cent of GP referrals are using the Choose and Book system.
- iii. The analysis above refers only to statistics for admitted patients, i.e. those requiring treatment following diagnosis. The DH have recently started publishing RTT times for non-admitted patients. In October 2007 this was 77 per cent.
- iv. Best and worst figures for NHS Trusts refer only to those who carried out more than 100 operations in x 2007 and in more than one specialty.
- v. The relevant data is taken from: http://www.performance.doh.gov.uk/rtt/provider.html and http://www.performance.doh.gov.uk/rtt/commissioner.html.
For more information ring:
James Gubb 020 7799 6677 (w) or 07930 243570 (m)
Robert Whelan 07732 674476
The Civitas report, Why are we waiting? is available below.
Why are we waiting?