The local picture on waiting times

by Rob Findlay

The latest RTT waiting times stats for England came out last week, so what do they tell us about local waiting times at Trusts and PCTs?

Interactive maps

If you want analysis for a particular Trust or PCT, by specialty, then you can look them up here. Or for an all-specialties view you can drill down through these interactive maps; just click a pin to get year-on-year comparisons of the total waiting list, over-18 week waits, and over-one-year waits. The pin colours show the number of over-one-year waiters.

Long-waits by Trust
Long-waits by Trust
Long-waits by PCT (Commissioner basis)
Long-waits by PCT (Commissioner)

The toughest backlogs

The maps show where the backlogs are, but how difficult will they be to clear? To answer this, we need a more detailed analysis, and we also have to make some assumptions because not all the data we need is published.

We’re working at all-specialties level, so we are assuming that resources can be allocated in ways that even out the pressures. We’re working with RTT waiting times, so we are assuming that all stages of pathway can be optimally managed. We’ve made estimates around addition rates, urgency rates, removal and cancellation rates, and patient booking tactics. Finally, we’ve assumed that waiting lists are being accurately reported to the Department of Health. That’s quite a lot of assumptions, so the results are illustrative not definitive. Nevertheless they are interesting.

Let’s look at how difficult it will be for Trusts and PCTs to achieve the new, improved target that 92 per cent of the waiting list (incomplete pathways) must be within 18 weeks.

If Trusts and PCTs address their backlogs by treating them in a “waiting list initiative” (aka “chopping the tail off the waiting list”), then they are almost certainly going to be wasting money. Our analysis suggests that 90 per cent of Trusts and PCTs should be able to achieve the new target without reducing the size of their waiting list. Many of the rest have only a trivial backlog to clear: less than two days’ work. Also, many of the Trusts with apparent pressures have suspected or known data reporting problems linked to the installation of new IT systems, which means that much of the apparent backlog will eventually evaporate through waiting list validation.

With all those caveats, then, here are the PCTs with the biggest backlog-clearance challenges ahead of them. The numbers show the number of working days’ activity needed to clear the backlog, even after good waiting list management has been put in place:

  • Wirral PCT: 33 days
  • Somerset PCT: 18 days
  • Bath and North East Somerset PCT: 10 days
  • Blackpool PCT: 6 days
  • Oxfordshire PCT: 6 days
  • Croydon PCT: 4 days
  • Warwickshire PCT: 4 days
  • Great Yarmouth and Waveney PCT: 2 days

The list of highly-pressured Trusts, unsurprisingly, shows some overlap:

  • Wirral University Teaching Hospital NHS Foundation Trust: 39 days
  • Taunton and Somerset NHS Foundation Trust: 24 days
  • Mid Staffordshire NHS Foundation Trust: 22 days
  • South Warwickshire NHS Foundation Trust: 21 days
  • Royal United Hospital Bath NHS Trust: 20 days
  • The Robert Jones And Agnes Hunt Orthopaedic Hospital NHS Foundation Trust: 13 days
  • Weston Area Health NHS Trust: 11 days
  • Winchester and Eastleigh Healthcare NHS Trust: 9 days
  • Oxford Radcliffe Hospitals NHS Trust: 8 days
  • Yeovil District Hospital NHS Foundation Trust: 8 days
  • Blackpool Teaching Hospitals NHS Foundation Trust: 7 days
  • Imperial College Healthcare NHS Trust: 5 days
  • Queen Victoria Hospital NHS Foundation Trust: 4 days
  • Croydon Health Services NHS Trust: 3 days
  • Bradford Teaching Hospitals NHS Foundation Trust: 2 days
  • Tameside Hospital NHS Foundation Trust: 2 days
  • James Paget University Hospitals NHS Foundation Trust: 2 days

Where time stands still

I’d like to pick out one of these Trusts because there is something strange about its waiting list. The wonderfully-named “The Robert Jones And Agnes Hunt Orthopaedic Hospital NHS Foundation Trust” (usually shortened to the RJAH) is a lovely specialist Orthopaedic hospital in the Welsh borders, set in beautiful hilly countryside. Their waiting list has a hill in it too, quite a big one, and it looks like this (see the dotted red line; data from the Department of Health):

RJAH incomplete pathways, November 2011
RJAH incomplete pathways, Orthopaedics, November 2011

That’s quite a peak. Luckily for the Trust, it lay just below 18 weeks in November, so they just managed to achieve their admitted patient target (90% within 17.8 weeks) and non-admitted patient target (95% within 18.0 weeks) during November. But how are they going to cope in December, when the peak has moved on and will be hitting 22 weeks?

Except that this peak isn’t going to move on. Curiously, it always stands still. Here is is the previous month’s peak, in October:

RJAH October 2011
RJAH incomplete pathways, Orthopaedics, October 2011

Like the Welsh hills around the hospital, this peak stays where it is. It has remained in exactly the same place ever since it first appeared from nowhere in October 2009. Actually, not quite from nowhere, because one can hardly help noticing that the Trust’s over-one-year waiters disappeared at exactly the same time. Here is the moment the peak appeared:

RJAH Orthopaedic incomplete pathways, Sept and Oct 2009
RJAH Orthopaedic incomplete pathways, Sept and Oct 2009

How are we to explain this phenomenon?

It can’t be clock pauses, because incomplete pathways data is not supposed to be adjusted for pauses. I wrote to the Trust a month ago to offer them an opportunity to provide an explanation, but they have not responded. So as things stand, I am struggling to think of an innocent explanation, and if anybody can come up with one then I’d like to hear it.

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