Waiting times: Not again?

  |   MBI Perform

Unfortunately, all of our predictions during the last 12 months on waiting times have come true. Despite numerous warnings, the NHS and the government now have a big problem. We wish it wasn’t so but now we need to answer the following questions:


  • What is happening?
  • What should be done about it?
  • What will actually be done about it?


Look at the table below:




Notice two things: the numbers of patients waiting in the top two categories (between 0 and 18 weeks) are not growing – they are flat.


However the numbers in the next two categories, shown in the red box, have grown significantly. These are patients who are waiting more than 18 weeks for treatment.


Put simply, hospitals are allowing longer waiting patients to continue waiting whilst shorter waiting patients are continuing to be treated. How can this be?


In our blog “Tip of the Iceberg” in January, we highlighted the NAO report saying:


“NAO report into NHS waiting times hits the headlines, highlighting serious discrepancies in how reported figures have been ‘miscalculated’”


Jeremy Hunt said at the time that the NHS was not fiddling the figures deliberately – we plainly disagree. The figures above show how the NHS is systematically allowing the number of longer waiting patients to grow whilst maintaining the same levels of shorter waiting patients. They are cherry picking short waiting patients in order to hit performance standards. This is both unacceptable and entirely predictable.


In our blog of the 27th June 2013 we predicted this would happen:


So where next? It’s obvious really. Emergency departments struggling, leads to more emergency admissions. More emergency admissions lead to fewer beds in the system. Fewer beds in the system lead to cancelling elective operations. Cancelling elective operations lead to failure to treat patients within the 18 week Referral to Treatment (RTT) time. The domino effect.


We also warned the government that they had a very serious problem:


Lastly, the government has a problem with 18 weeks. It is now law that a patient has the right to be treated within 18 weeks. If Trusts become unable to meet this law – patients are entitled to go to a private institution paid for by – you guessed it – the NHS


Given that we now a year away from a general election, this problem has come home to roost.


What should be done?


In our experience RTT is ruthlessly simple.


We have previously set out the 7 rules that need to be adhered to and our work with hospitals is based around:


  1. Pathways with ‘hand-offs’ to other departments need to be concentrated on first: particularly diagnostic tests, prosthetics, orthotics and consultant to consultant referrals in other specialties.
  2. Information reports need to be aligned to operations: we often find information departments who do not understand RTT or Cancer and produce meaningless reports of little value to operational teams and clinicians.
  3. Pay attention to clinic outcomes: this is often the most critical stage of recording in RTT and Cancer. Failure to record properly results in increased unnecessary validation being required.
  4. Identify ways to reduce the number of outpatient appointments required with consultants in secondary care by ensuring patients access care at the most appropriate place: we live in the 21st century with a raft of technology available to us, phone consultations, online consultations and reducing the need for patients to actually come to the hospital should be the norm.
  5. Adherence to RTT rules:  regular audits and formal training programs for all clinical administration staff need to be seen as a priority in managing pathways. The recent example of Cancer waiting times not being recorded accurately at Colchester University FT proved the value of scrutinising how things are being recorded and staff trained.
  6. Understand your Clinical administration functions: We find this to be the first area to be cut when an organisation is in financial difficulty yet this is the key to managing patients through the hospital – this is a clear diseconomy.
  7. Work to minimise cancellations: We often find operations which require HDU and ITU input being scheduled on the same day when they could have been spaced a day apart – the lack of scheduled theatre planning results in unnecessary cancellations which the system cannot cope with during winter.


The NHS needs to go back to basics on this topic:


The NHS is currently policy driven rather than service driven. This highlights a need to move the pendulum right back towards operational expertise – I know it’s not sexy, no one goes on the BBC news to explain how to book patients properly but it’s what needs to happen. Too many of our leaders are lost in a haze of strategic waffle and deliberation. This highlights the need for on the ground experience.


What will be done?


Given that the coalition government can ill afford headlines showing waiting lists have got worse on their watch we are confident that there are some very worried politicians right now. When we get worried politicians we get knee-jerk reactions.


Do not be surprised to hear of a pot of money being made available in order to rapidly get all of these long-waiting patients off the waiting list in the upcoming months. Whilst this is a good thing ultimately, it is a monumental waste of taxpayer money.


There will probably be an “amnesty” on clearing the backlog and a hope that the regulators continue to show a lack of understanding on RTT and Cancer Waiting Times.


Firstly, hospitals need to focus on doing the basics properly – the move away from policy and back to operational expertise should be relentless.


Secondly, it is clear that mismanagement of waiting times has been in place for a long time.


The only sustainable answer to fixing this is to put each patients waiting time in the hands of the patient themselves. Empower them to know their waiting time, the simple rules of RTT and empower them to ensure they are treated within it. Transparency and health navigation support will be necessary for vulnerable patients.


The era of system based solutions is over.