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Underlying pressure still rising on elective waiting times

There were small improvements in the numbers of patients waiting longer than 1 year and 2 years, according to the latest English referral-to-treatment (RTT) statistics up to the end of February 2022. However the underlying pressures on waiting times continued to worsen, and the waiting list continued to grow with hospitals struggling to admit patients for inpatient and daycase treatment.

More worryingly, the waiting time from referral to diagnosis and ‘decision to admit’ edged up from 39.5 to 39.8 weeks (i.e. over 9 months). That is a long time for those patients who have unsuspected cancer or other urgent conditions, who will be on the list in significant numbers because because the second most common route towards a cancer diagnosis is an ordinary GP referral (i.e. not on a rapid cancer pathway).

NHS England are currently calling for 2 year (104 week) waits to be largely eliminated by July 2022, 18 month (78 week) waits by April 2023, and one year (52 week) waits by March 2025. It is certainly important to keep a lid on ultra long waiting times, which can otherwise spiral out of control (as the multi year waits of the 1980s showed).

But beyond those ‘long tail’ extreme waits, it is more important to reduce waits to diagnosis and decision than RTT waits overall, and doing so would align with the existing drives to transform outpatients, expand advice and guidance, establish diagnostic hubs, and increase clock stops. There is a danger that ratcheting down RTT waits in these early years of elective recovery will increasingly come into conflict with those other more important goals.

In the following discussion, all figures come from NHS England. If you have a national statistic that you’d like to check up on, you can download our waiting times fact checker.

For analysis of waiting times performance at a particular organisation, visit our reports page, or our map of the latest RTT waiting times across England.

The numbers

New patients were added to the waiting list (as ‘clock starts’) at a slightly slower rate than pre-pandemic, continuing the pattern since last May. There is still no sign of the ‘missing referrals’ from the first year of the pandemic flooding back, and perhaps they never will: it is starting to look as though the thresholds at which patients seek care have instead changed for the long term.

The rate that patients were discharged from outpatients, and otherwise removed from the waiting list for reasons other than admission, also remained slightly below pre-pandemic levels.

Admissions for treatment as inpatients or daycases, which require patients to physically come into hospital (with all the covid infection controls that implies) remained significantly lower than pre-pandemic.

The net result of near pre-pandemic demand and below pre-pandemic activity is a growing waiting list. This points to rising underlying pressure on waiting times.

So it may be a surprise to see that actual RTT waiting times fell very slightly; this will be explained below. However waiting times from referral, up to diagnosis and ‘decision to admit’ increased slightly to 39.9 weeks, which is a long time to wait when you aren’t sure what is really wrong with you.

RTT waiting times are a function of both the size and shape of the waiting list. As we saw above, the size increased. The chart below shows that the shape improved. The net result was the slight fall in overall RTT waiting times above.

At specialty level there was a sharp improvement in the very longest waiting specialties: plastic surgery and orthopaedics. This may reflect efforts to achieve the RTT waiting time targets set by NHS England. Waiting times in medical specialties, which typically have high proportions of clinically urgent patients, increased.

The distribution of waiting times was little changed across the board. When making the comparison with February 2021 waits, remember that the data only went up to 52 weeks in those days so we do not know how many patients were waiting longer.

Referral-to-treatment data up to the end of March is due out at 9:30am on Thursday 12th May 2022.