Officially, England only just missed the 18 week target. Unofficially things were much worse because of non-reporting trusts. What is most worrying is that the waiting list has grown by over 12 per cent year on year, Rob Findlay explains.

England officially missed the 18 week target by the narrowest of margins at the end of January - just one patient per trust. The breach was so narrow that the official Statistical Press Notice was obliged to report “92.0 per cent (91.995% to three decimal places) of patients waiting to start treatment (incomplete pathways) were waiting up to 18 weeks”.

Unofficially, though, the figures were considerably worse. If we add back in the last reported positions at non-reporting trusts, only 91.5 per cent of waiting list patients were within 18 weeks.

Even this is only an estimate, and probably not a very good one: we know for instance that Barking, Havering and Redbridge University Hospitals trust has recently counted some 1,015 one-year-waiters on its lists, compared with a last reported position of zero one-year waiters. So the official statement that “727 patients were waiting more than 52 weeks” is clearly just plain wrong, and the official near miss on 18 weeks must also be considered unreliable.

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

England-wide picture

January’s improvement in 18 week waits was a surprise, because usually patient scheduling is relatively poor after new year and long waits go up as a result. This year bucked the trend because the NHS pulled out the stops to treat as many long-waiting patients as possible (shown in the chart below by the long waiting times of patients chosen for treatment for admitted and non-admitted care - the longest since 2008).

Taken in isolation, treating long waiters is a good thing - better than keeping them waiting. However, it is possible to have too much of a good thing, if it means keeping clinically urgent patients waiting in order to release capacity for those long waiters. The bigger the waiting list, the harder it is to achieve the waiting time target, and the greater the temptation to delay urgent patients to get those long waiters treated. But clinical priorities should always come first.

01 92 per cent of waiting list

01 92 per cent of waiting list

The official statistics (which are used in all these charts) don’t tell the whole story, and we can have a stab at a more realistic picture by adding back in the last-known positions at non-reporting trusts. However, some of these trusts have not reported for ages, and (as noted above) Barking, Havering and Redbridge University Hospitals  Trust alone has recently counted over 1,000 one-year waiters on its lists. So the estimated position below should probably also be regarded as somewhat optimistic.

02 non reporting trusts

02 non reporting trusts

The number of patients waiting was steady during January, which is normal for the season. However, the year-on-year growth was huge at 367,000 patients (on the official figures), which is over 12 per cent. Increases in waiting times are inevitable when the queue is lengthening so rapidly.

03 waiting list in england

03 waiting list in england

Admissions per working day were flat on recent years (again). Which plainly isn’t enough to stop the waiting list from growing.

04 admissions per working day

04 admissions per working day

For what it’s worth, here are the official figures on long waiters. But we can’t actually believe them, because so many more patients are waiting at non-reporting trusts.

05 long waiters

05 long waiters

The improvement in waiting times was uneven across the specialties, with long-waiting surgical specialties generally improving and short-waiting ones deteriorating. Among the medical specialties, Neurology edged back inside 18 weeks.

06 92pc of waiting list by specialty

06 92pc of waiting list by specialty

The proportion of local services achieving 18 weeks (at trust-specialty level) deteriorated very slightly in January.

07 services achieving 18 weeks

07 services achieving 18 weeks

Waiting times at local service level converged slightly on 18 weeks, with long waits improving and short waits deteriorating slightly, consistent with the picture at specialty level.

08 distribution of waits by service

08 distribution of waits by service

Local detail

Brighton and Sussex University Hospitals Trust remain at the top of the table with unchanged waiting times of 29.9 weeks, and waiting times lengthened at two of their nearby providers as well: Brighton & Hove Integrated Care Service and Sussex MSK Partnership.

North Bristol NHS Trust have improved their position, and made some inroads into their one-year waits too, so congratulations to them.

09 top twenty

09 top twenty

Data for February 2016 is due out at 9:30am on14th April. I am anticipating another breach of 18 weeks (if non-reporting trusts are added back in), followed by a recovery of 18 weeks in the March figures. But then waiting times are full of surprises.

Rob Findlay is a specialist in NHS planning, scheduling and wait times.