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Lansley and Neil in the waiting times trap

by Rob Findlay

On 3rd October, Andrew Neil did an extended interview with Andrew Lansley. Waiting times cropped up (at 19m24s), and a throwaway remark by Andrew Lansley revealed something very interesting. He said:

The first point you made was, waiting lists – in fact, what I think you meant, waiting times, but you said waiting lists have gone up, they haven’t…

There is evidently a distinction in Andrew Lansley’s mind between waiting lists and waiting times. But what is it?

Back in the 1980s we all talked about waiting lists, as in “there are this many patients on the waiting list, up from that many”. Then people quite rightly observed that if you are a patient on the waiting list, you don’t really care how many other patients there are: you just want to know when you are going to be treated. You fear that you might wait as long as some of those poor patients you read about in the newspapers, who wait for many years and sometimes even die waiting.

Because of those fears, maximum waiting times came to the fore. In the early 1990s the 2-year maximum wait for inpatients and daycases was achieved. Then 18 months. And the NHS was ready to push for a 12 month maximum inpatient wait when the Conservatives lost power in 1997. At the same time there was also a lot of counterproductive bragging by the Department of Health about how many patients were being treated within 3 months (in other words, how much unjustified queue-jumping there was), but public attention was very much focused on those patients who were waiting the longest.

The incoming Labour Government achieved great things on NHS waiting times: firstly by monitoring the whole referral-to-treatment pathway instead of selected stages (no mean feat in itself), and then by improving beyond recognition the waiting times for that whole pathway. But at the same time, there was a shift in the meaning of “waiting times”, and that is the shift revealed in Andrew Lansley’s remark.

Nowadays when politicians talk about “waiting times”, most journalists (and as a result, most people) think they are talking about waiting lists. We know this because of the way the headlines are written. But they aren’t talking about waiting lists at all. The statistics that Andrew Lansley quoted in the interview, and indeed the statistics that Andrew Neil threw at him, were all about admitted patients, not patients still on the waiting list.

So when Andrew Lansley said that average waiting times have come down, he was referring only to those patients lucky enough to have received treatment. They are not necessarily representative of those still waiting, nor is the median very enlightening as a statistic. And if average admitted waits come down, without a corresponding reduction in the number of patients on the waiting list, it isn’t good news either.

Likewise, when Andrew Neil said that the number of over-18-week waiters has gone up by 20 per cent, he wasn’t talking about the waiting list. He was quoting figures that show a rise in long-waiting patients being admitted for treatment. And that’s a good thing, actually, because it means the NHS is clearing its long-wait backlog more quickly. Amazingly, Andrew Lansley didn’t pick this up and say that it shows just how marvellous everything is. (And neither does David Cameron when Ed Miliband levels similar charges.)

So it seems that the term “waiting times” has been twisted into some kind of opposite to “waiting list”. It refers to patients who have been treated, and aren’t on the waiting list any more. All the statistics have been twisted around as well. And everybody has fallen into the trap.

That explains why journalists pick statistics that are actually good news, and present them as bad news. And why Her Majesty’s Opposition does the same. Government ministers, in their ignorance, fight back with statistics that are actually bad news, and present them as good news. The public just nods along, always fearful that things are getting worse, because they are getting no useful information from anybody.

How can we break this cycle? Any one of the players could do it: Government, Opposition, or journalists. Or indeed the Department of Health, who after all give Government Ministers their briefings. Anyone want to go first?

This post first appeared at HSJ blogs
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