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Latest on waiting times – signs of recovery?

24/05/2011
by Rob Findlay

English waiting times improved in March, but it’s surprisingly difficult to tell from the government’s press notice. There are so many waiting time measures being tracked now, that it is hard to work out what is going on.

So what did happen in March?

As spring blossomed, Trusts sharply increased the number of patients they treated from the waiting list, and set about tackling their long-wait backlogs. As a result, the number and proportion of over-18-week waiters on the waiting list fell to pre-winter levels, which is good news for patients and the service. The number of very long waiters over 52 weeks also reduced slightly to 14,355.

But bringing in all those long-waiters comes at a price: it looks bad on the main waiting time targets, which track the patients treated, not the patients still waiting. Admissions within 18 weeks deteriorated to 89.6%, the “worst” since mid-2008. Because this “decline” is an artefact of tackling long-wait backlogs, it should “recover” as the benefits of this work feed through. (The “scare quotes” around those words indicate that I don’t believe those measures are very helpful, for reasons that are illustrated here.)

In the following chart, both lines show 90th centile referral-to-treatment (RTT) waiting times (i.e. 10 per cent of patients waited longer than the time shown by the line). The solid line shows how long admitted patients waited (this remains over 18 weeks), and the dotted line shows waiting times for those patients who are still waiting (this has peaked and is now coming down).

 

90th centile waiting times for admitted and still-waiting patients, since 2007

90th centile waiting times for admitted and still-waiting patients, since 2007

 

For the full details, a waiting time fact-checker is available for download here:

Waiting_times_fact_checker-Gooroo.xls

It contains the complete time series across all RTT waiting time measures. So if you hear a politician saying that waiting times went down (or up) in March, you can check the facts for yourself.

Maps of waiting time pressures

Like everything else in the NHS, waiting times vary enormously from place to place. So here is a collection of interactive maps, one for each main specialty, showing the underlying waiting time pressures around England. Each Trust has a pin stuck in it, and the pins are colour-coded according to the RTT waiting times of the longest-waiting 10 per cent of the waiting list.

Click any Trust’s pin to get more detail in a balloon. You can also click the Trust’s name in the balloon for a more comprehensive analysis with benchmarking and time trends (this is delivered via a separate website and requires free registration).

General Surgery
Urology
Orthopaedics
ENT
Ophthalmology
Oral Surgery
Neurosurgery
Plastic Surgery
Cardiothoracic Surgery
Gynaecology
Total of all specialties

Variations between Trusts

It is fascinating how different Trusts respond to waiting time pressures in different ways. Some try to reduce waiting times by treating their long-waiters (even if that causes a breach of the headline target), and some stick to achieving their headline targets (even though that causes the backlog to grow). Although the former approach is better for patients, the penalties (which can include heavy contractual fines) make it understandable that many Trusts choose the latter.

The next exhibit is a video: a time series showing the different pressures and behaviours of all English Trusts. Each Trust is represented by a pair of dots, one red and one blue.

Both of these dots show the waiting times of the longest-waiting 10 per cent of patients; but the red dots are based on those patients who are still waiting, and the blue dots are based on those patients who were lucky enough to be admitted. Each monthly chart is sorted by the red dots, so those Trusts with the greatest underlying pressures are always on the right.

You can view the video on YouTube here: (If you are interested, the curious history of how 18 weeks was achieved is discussed here.)

The final chart in the video is:

90th centile waiting times by Trust, comparing admitted and still-waiting

90th centile waiting times by Trust, comparing admitted and still-waiting

The two outlier Trusts with very large waiting time pressures, shown by the two dots at the top right, are Kingston Hospital NHS Trust and University College London Hospitals NHS Foundation Trust. Between them, they account for over 20 per cent of the over-52-week waiters in England.

Kingston has experienced a very sharp increase in waiting time pressures since October 2010, and UCLH has been struggling with long-wait pressures for over a year. UCLH in particular illustrates how it is possible for Trusts to achieve the admission-based 18 week targets even if they have large numbers of long-waiters on their waiting lists.

Kingston - All specialties

Kingston - All specialties

UCLH - All specialties

UCLH - All specialties

Going back to the chart with the red and blue dots: the point where the red line crosses 18 weeks is an interesting indicator. It shows how many Trusts are experiencing relatively low waiting time pressures, to the extent that less than 10 per cent of their waiting list is over 18 weeks.

This indicator peaked in the month of the General Election, May 2010. Then it deteriorated until New Year, and has partially recovered since then; as the following chart shows.

Proportion of Trusts where less than 10% of patients still waiting are over 18 weeks

Proportion of Trusts where less than 10% of patients still waiting are over 18 weeks

So the March 2011 statistics paint a hopeful picture for English waiting times, with pressures reduced since the winter. April brought a winter of a different kind, however, as the financial pressures started to bite in earnest. We will all have to keep a close eye on waiting times.

This post first appeared at HSJ blogs.
Referral-to-treatment data from Department of Health. Mapping by BatchGeo.

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