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.”