Most Trusts are achieving the 18 week operating standard. But some aren’t, and others are slipping towards failure. What should they do about it? Throw scarce money at it by creating extra capacity? Or can the problem be fixed more cheaply by managing better? And how can they tell which is the right approach?

We are currently writing to English Trusts, indicating their Trust’s likely best approach in all main surgical specialties. This post puts those individual reports into context, showing the national picture and explaining in more detail how the reports were constructed.

Here is a chart showing General Surgery at English hospital Trusts. (The format was introduced in a previous post.)

Three Trusts have been picked out in different colours. Here is the distribution of referral-to-treatment (RTT) waiting times for the red Trust:

The waiting time report being sent to this Trust says (for General Surgery):

• Achieving 90% within 18 weeks? No – only achieving 70%
• Clinical priorities under pressure? Indication of some pressure to delay urgent patients (proportion admitted within 4 weeks RTT is in lowest quartile)
• Scope to reduce waiting times by better scheduling? Possible scope for significant improvements at modest cost by improving scheduling

Looking at the charts, we can see where these statements come from.

• On the bubble chart, the red bubble lies well to the right of the “90% within 18 weeks” line, and is out at 30% breaches (i.e. 70% within 18 weeks), showing that the 18 week operating standard is not being met.
• Looking at the vertical position of the red bubble, we can see the proportion of patients treated within 4 weeks RTT: this Trust lies between the bottom line (lowest decile) and second-bottom line (lowest quartile), so the Trust’s report states that there is an indication that clinical priorities might be under pressure, because the proportion treated quickly is in the lowest quartile.
• Looking at the red column chart, we can see that a significant proportion of patients are admitted with intermediate waiting times from 4 to 15 weeks. Because these cohorts form a majority of the non-urgent patients, the Trust’s report states that waiting times might be reduced by improving scheduling. This statement is only suggestive, because there may be good reason (such as subspecialisation between consultants preventing waiting time pressures from being shared across the specialty) why better scheduling might have limited impact.

For the Trust picked out in amber, their waiting time report says:

• Achieving 90% within 18 weeks? Only just – 92%
• Clinical priorities under pressure? No indication of pressure to delay urgent patients
• Scope to reduce waiting times by better scheduling? Likely scope for major improvements at modest cost by improving scheduling

because

• The amber bubble is only just to the left of the 90% line.
• The bubble is above the lowest quartile (second-from-bottom line), so there is no indication (based on the proportion treated within 4 weeks RTT) that clinical priorities are being squeezed.
• Lots of patients are being treated with intermediate waiting times – neither as urgents nor as 18-week pressures.

And here is the green Trust:

This Trust’s report says:

• Achieving 90% within 18 weeks? Yes – 97%
• Clinical priorities under pressure? No indication of pressure to delay urgent patients
• Scope to reduce waiting times by better scheduling? Possible scope for significant improvements at modest cost by improving scheduling

It so happens that all three examples have indicated scope to reduce waiting times by better scheduling, but this is not always the case. In General Surgery we indicate “likely” scope for 45% of Trusts, “possible” scope for 25% of Trusts, and “limited scope” for the remaining 30% of Trusts.

Finally, here are the bubble charts for the other main surgical specialties.