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Trusts ‘stop the clock’ to hit targets

Concerns have been raised that some trusts have excessively used “clock pauses” in order to achieve the 18 week referral to treatment target.

Analysis of Department of Health data by Rob Findlay examines the performance of specialties at trusts against the target of 90 per cent of patients being admitted within 18 weeks.

He compared the data adjusted for clock pauses - which allow trusts to effectively extend the 18-week limit in cases where patients are seen to decline treatment - with unadjusted data measuring the total wait patients experienced.

Trusts with the biggest gap between adjusted and unadjusted waits (June monthly snapshot)

SpecialtyTrustAdjusted waiting time (weeks)Unadjusted waiting time (weeks)Difference (weeks)Number of admissions
OrthopaedicsHampshire Hospitals FT17.737.019.3401
OrthopaedicsThe Royal WolverhamptonHospitals17.931.513.6320
OrthopaedicsWest Middlesex University Hospital17.931.113.356
Oral SurgeryNorth West London Hospitals17.829.311.6150
GynaecologyYork Teaching Hospital FT17.728.010.350

Source: NHS Gooroo. Only specialties with 50 patients or more included. Some figures have been rounded

Under DH rules, clock pauses can only be initiated by the trust if the patient has declined two reasonable dates for admission; “reasonable” is defined as the trust giving the patient at least three weeks’ notice.

For specialties reporting a 90th percentile wait of between 17-18 weeks - and so only just meeting the target - 28 per cent had deducted an average of one to three weeks per patient for clock pauses.

A further 11 per cent of such specialties had average clock pauses of three to five weeks, while another 6 per cent had an average clock pause of more than five weeks.

Outside of the 17-18 week range, only 24 per cent of specialties had a difference between the unadjusted figure and figure accounting for clock pauses of more than one week.

Mr Findlay said: “I am not making a blanket accusation that any service narrowly achieving the adjusted admitted target with just the right level of clock pauses is misusing clock pauses in order to achieve the target, but I think it is fairly clear that some of them probably are, and some systematically.”

In a blog for HSJ, Mr Findlay, founder of Gooroo, which specialises in waiting times dynamics, said this mattered less than it might have done before the introduction of the incomplete pathways target in this year’s NHS operating framework. This requires 92 per cent of pathways to be completed within 18 weeks.

At 19.3 weeks Hampshire Hospitals Foundation Trust’s orthopaedic waiting list had the biggest difference between the adjusted and unadjusted wait. Unlike the other four outliers, for which the majority of clock pauses occurred in weeks 17 or 18, most of the trust’s pauses are in weeks five and six.

A spokeswoman for the trust said that it had a “very active validation team, which is focused on ensuring that all legitimate use of suspensions are included where appropriate”.

Patient holidays and poor patient health were among the common reasons given for high levels of clock pauses by other trusts.

A DH spokesman said: “We take any misreporting of NHS waiting times extremely seriously and will ensure that any examples of this are thoroughly investigated.”


Readers' comments (6)

  • It is a shame that the vast amounts of money spent on monitoring waiting time figures are not spent on increasing the services generating them. This is a good example of the red tape that is strangling public services that Cameron says he has declared war on.

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  • Is the full list available? Wouldn't mind spotting where my trust is to see how big an issue it is!

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  • Agree with Anon 10:58 could we get a full list

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  • Anonymous 12/9/12 – 2.42

    Ah, but if Cameron gets rid of the red tape someone will still require stats to be provided to they can see how effective getting rid of red tape was!

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  • Re full list, NHS Gooroo has attached a spreadsheet at the bottom of his blog highlighting some local examples:

    Definitely worth a read.


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  • Thanks for directing us towards Rob's blog, which reveals this to be a rather flaky bit of self promotion for his consultancy practice.

    This is an important issue which he manages to trivialise by looking at small numbers. By setting his threshold for consideration at specialities with only 50 cases per month, he is looking at specialities where the clock may have stopped for genuine reasons for 5 or 6 patients. Use of quartelry rather than monthly figures for small specialities would increase the chance of producing robust figures.

    Rob should treat HSJ readers, and NHS trusts, with a bit more respect. He doesn't stand much chance of getting consultancy work from my organisation if this is the standard of work he churns out!

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