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Waiting times: “strong” or an “embarrassment”?

by Rob Findlay

So, is NHS performance on waiting times, “strong” or an “embarrassment
(@HSJEditor via Twitter)

How did the HSJ (“NHS reports strong performance on 18 weeks targets”) and the Guardian (“Number of NHS patients waiting over 18 weeks for treatment up 27%”) manage to draw opposite conclusions from the same waiting times statistics?

The Guardian explained its numbers thus:

A total of 26,417 people in England waited more than 18 weeks to be treated in February this year compared to 20,662 in May 2010, when the government was formed – a 27% rise.

Looking at the data (spreadsheet here), we can see where those figures came from. 26,417 is the number of patients admitted as inpatients and daycases, during February 2012, who had waited over 18 weeks (adjusted for clock pauses) before being treated. 20,662 is the corresponding figure for May 2010, the month of the General Election.

That’s a 27.9 per cent increase. But an increase in what? Not in the “number of NHS patients waiting”: if you look at the waiting list figures (the so-called “incomplete pathways”), you find that the number of over-18-week waiters still on the waiting list fell by 16 per cent over the same period, from 209,411 to 175,549 (which, as it happens, is an all-time low).

No, the increase was in the number of over-18-week waiters being treated, and at this point we need to remind ourselves that treating long-waiting patients is a good thing (and certainly much better than leaving them on the waiting list). The NHS in England has recently been treating a lot more long-waiters in an effort to clear the over-18-week backlog: in the year to February 2012 some 337,264 over-18-week waiters were admitted (9.3 per cent of all admissions), compared with only 283,128 (7.8 per cent of admissions) in the previous 12 months.

So the Guardian headline needs a bit of adjusting. Using the same figures it could have said “Number of NHS patients treated after waiting over 18 weeks up 27%”. Or, to put the focus on “NHS patients waiting”, it might have read “Number of NHS patients waiting over 18 weeks for treatment down 16% to record low”. Either way, it’s hardly “a huge embarrassment”.

A similar confusion over the figures popped up elsewhere this week, with the CQC’s large-scale survey of inpatients reporting that waiting times had gone up. Again, the figures show that the number of long-waiters picked up in the inpatients survey had increased, which again is a measure of long-waiters being treated not of long-waiters still waiting.

What is surprising about the inpatient survey is the very high proportion (14 per cent) reporting that they had waited longer than six months, when according to the national RTT statistics the figure for the same period (October 2011 to January 2012) was only 3 per cent. Perhaps the answer lies in the wording of the question: according to the summary report “the survey asked respondents how long they had to wait to be admitted to hospital, from the time they first talked to a health professional about being referred for a hospital admission”. This isn’t quite the same as the waiting time from referral to treatment, which may (or may not) explain the difference.

So what’s the verdict: “strong”, or an “embarrassment”? Looking at the waiting list, in February 2012 the numbers of patients waiting longer than 18, 26, 39 and 52 weeks were the lowest ever recorded. So were the 90th, 92nd and 95th centile waiting times. So (not that it means very much) were the mean and median waiting times. A “strong” performance? I hope we can all agree that it is.

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