Yesterday I blogged about the England-wide picture waiting times. Today we’ll dive into the detail, and look at the variation between Trusts.

The all-specialties position

First, let’s look at the variation in waiting time pressures around the country, for all specialties added together. In the chart below, each Trust is represented by two dots: a red dot showing how long the top 10 per cent of the waiting list is waiting (i.e. 90th centile RTT waiting time for incomplete pathways), and a blue dot showing how long the top 10 per cent of admitted patients had waited (i.e. 90th centile RTT waiting time for adjusted admitted pathways).

So the red dots show, roughly speaking, how big the long-wait problem is at each Trust, and the blue dots show what they are doing about it.

Over to the right, where we find Trusts with the largest pressures on their waiting lists (the red dot is high), we can see that many are admitting lots of long-waiters in an effort to solve the problem (the blue dot is also high). Unfortunately if the blue dot is above the 18-week line it also means they are failing against the government’s main RTT waiting time target (which, as I am still not tired of pointing out, penalises Trusts that do the right thing and treat their long-waiters).

But we can also see that many Trusts with large long-wait pressures on their waiting lists are not tackling their long-wait problems, and are instead choosing to achieve the government’s main target. I don’t blame them for doing this; the penalties can be severe. The problem is the target, not the Trusts who choose to achieve it. Until the government changes the target so that it focuses on patients who are still waiting, not those treated, the extreme long-waits we are now seeing will continue to worsen.

Which Trusts have the biggest waiting time pressures? Here’s the top twenty (which may or may not be missing Kingston and St George’s, neither of whom submitted data for May):

We can also see in the above chart that 68 per cent of Trusts have red dots below the 18 week line, which continues the improvement seen since the winter as the following chart shows:

Specialty by specialty

Drilling down to the individual specialties, we find even more variation. Here are the England-wide pressures on the waiting list, by specialty over time:

With the exception of small upticks in ENT, Oral Surgery and Gynaecology, all surgical specialties improved in May. Of the big surgical specialties the greatest pressures are, as usual, in Orthopaedics (90 per cent of the waiting list over 19.6 weeks) although the gap is narrowing with Urology (19.3 weeks) and General Surgery (18.8 weeks).

Around the country there is, as for the all-specialties picture, enormous variation from Trust to Trust. So here are some interactive maps of the pressures around the country, specialty by specialty. You can click on any pin to get a balloon with details of that Trust, and then click the Trust name in the balloon to get a fuller analysis:

General Surgery | Urology | Orthopaedics | ENT | Ophthalmology | Oral Surgery | Neurosurgery | Plastic Surgery | Cardiothoracic Surgery | Gynaecology | All specialties

Finally, to illustrate, here is the Orthopaedics map. Go ahead and click it!

 This post first appeared at HSJ blogs