The latest guidance is massively simplifying the rules on 18 week waits. There is now a huge opportunity to do the same for local waiting times management as hospitals are now free to focus on keeping queues short, and scheduling patients safely and fairly

Reclining by a Pacific beach, sipping an ice cold beer? Reaching the top of a high mountain on a clear spring day? Or reading the latest waiting times guidance from Monitor, the NHS Trust Development Authority and NHS England? It’s a tough choice.

Seriously, when has official guidance ever been such an enormous pleasure to read?

‘NHS England are already consulting on the formal contract variation to abolish the perverse sanctions’

The 24 June letter laid out in glowing detail exactly how dead the perverse admitted and non-admitted targets are.

Penalties are being refunded. The regulators have stopped acting on them. And although there is a bit of work to do to ensure that trusts’ patient access policies accord with the referral to treatment Rules Suite and are published, it is surely the right thing to do.

The Rules Suite itself is changing too, because the fiddly and complicated business of clock pausing goes out of the window when the adjusted admitted data series is retired in October - none of the surviving data series are adjusted for pauses.

Under the new regime

All the other paperwork needs to catch up with reality too, so NHS England are already consulting on the formal contract variation to abolish the perverse sanctions.

As I anticipated last year, they want to preserve the overall burden of sanctions by doubling to £300 the fine per excess incomplete pathways breach. Between now and October the £150 rate still applies, so the burden of sanctions will be lighter for the next few months.

What are things going to be like under this new regime?

The first and most important thing to say is that all patients continue to enjoy a right to consultant led treatment within 18 weeks of referral under the NHS Constitution. That’s all patients, not just 92 per cent of them - the tolerance is there to allow patients to delay their treatment if they choose.

The second point is that, although (if interpreted literally) the incomplete pathways target is about a couple of weeks looser than the old admitted target, it is a much firmer limit once you reach it.

‘Hospitals are now free to focus on what is really important’

If you breached the old admitted target, there was always the option to “achieve” it again by admitting nine short waiters for every one long waiter, even if that meant leaving a lot of long waiters on the waiting list. The incomplete pathways target allows no such leeway: if you breach, you really do need to treat those long waiters.

The third point is that some people will, unfortunately, treat the new regime as a numbers game - looking for opportunities to stuff the denominator with unvalidated patients (which means they don’t really know who’s on the waiting list any more), and to cull the numerator by zealously removing or even discharging long waiters (only to see them come back again later).

Some may even stoop to cancelling urgent or follow up patients to make way for routine patients with 18 weeks on the clock (which is unsafe).

What all such actions have in common is that they provide only a little short term relief against the target, while storing up much larger and more dangerous problems for the future.

As the top of the office gets on with simplifying the paperwork and process around 18 weeks, there is a huge opportunity for managers to simplify their local systems too.

That is the advantage, indeed the whole point of having only incomplete pathways targets. Hospitals are now free to focus on what is really important: keeping queues short, and scheduling patients safely and fairly.

Rob Findlay is founder of Gooroo Ltd and a specialist in waiting time dynamics

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