Making sense of conflicting waiting times targets

by Rob Findlay

Treat your long-waiting patients!

Don’t treat your long-waiting patients!

You can forgive the NHS for being confused. A Trust with a long-wait backlog gets clobbered whatever it does: with fines under the NHS Contract if it treats its long-waiters, and via performance management if it doesn’t.

There is a way through the conundrum, but it’s messy. (At least the NHS can console itself with the thought that it didn’t make the mess in the first place.)

The key point is that, from April 2013, the target regime is expected to focus on the waiting list (when 92% of incomplete pathways must be below 18 weeks). So if you work at a Trust with lots of long-waiters then, whatever you do this year, you need to tackle that 18-week backlog.

Unfortunately, when you treat those long-waiters you will probably breach the admitted and non-admitted targets which live on, zombie-like, in the NHS Contract. If your PCT Cluster is sensible about it, they will voluntarily refrain from enforcing these zombie targets. (And, even if they don’t, being “performance managed” is perhaps more likely to keep you awake at night than the prospect of a fine.)

So in operational terms, if you have an 18-week backlog, the right thing to do is to treat your long-waiting patients, preferably with blessings from your PCT Cluster. This is more than just good tactics; it is consistent with the four principles of good waiting list management:

  • Treat more urgent patients more quickly
  • Treat patients with similar priority broadly in turn
  • Keep the longest waits to a reasonable level
  • In doing all this, don’t waste the available capacity

So that’s the operational approach. What about planning?

Here things get a little trickier, because you have two completely different kinds of target to juggle: the zombie targets based on patients as they are being treated, and the new ones based on patients who are still waiting. Happily it turns out that this conflict is easy to resolve.

In a well-managed waiting list (following the four principles above), it turns out to be easier to achieve the incomplete pathways target than the zombie targets. So the solution is simply to plan your activity and capacity to achieve the more difficult (i.e. the zombie) targets. In practical terms this means that, when you are running your planning model, you should set the waiting times targets to sustainably achieve 90% of admissions and 95% of non-admissions within 18 weeks; you do not need to model the 92% incomplete pathways target because it will automatically follow.

If all goes well then this muddle of targets should only last for a year. Then we can all focus on what is really important: stopping long-wait backlogs from building up in the first place.

In the meantime it is within the gift of PCT Clusters to resolve the confusion locally by choosing not to enforce the zombie targets in the NHS Contract, and so clear the way for performance management to bear down on the backlogs.

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