The government has said new contractual penalties to tackle “hidden” waits for elective procedures will not be introduced nationally for 15 months, HSJ can reveal.
Health secretary Andrew Lansley said in November he would “clamp down” from “next year” on the situation that allowed “hundreds of thousands to languish on hidden ‘still waiting’ lists”. HSJ last year revealed thousands of patients had waited more than a year for treatment.
The health secretary said in November: “If we bring it [tackling long waits] in to this system of making sure that patients’ interests are part of the contractual arrangements with hospitals - in the same way at the moment they have a contractual requirement within 18 weeks, then the operational standard is 90 per cent of patients should be seen and treated within 18 weeks if they are admitted to hospital and 95 per cent if they are not - then what we need to do is extend the same kind of contractual provision to this additional set of patients.
“What it means under the contract is if we set a figure at 92 per cent, for example, if they go beyond that and fail to meet that, for every 1 per cent they fail to meet that they could under the contract lose 0.5 per cent of their elective contract value.”
In the 2012-13 operating framework and quarter 2 report, both released late last year, the Department of Health said it would introduce a new target to encourage trusts to clear backlogs of long-waiters. The current target of treating 90 per cent of elective patients within 18 weeks can mean trusts are discouraged from admitting patients who have already waited longer than that.
However, HSJ has confirmed the new national contract for 2012-13, released on 23 December, does not introduce penalties associated with meeting the 92 per cent target.
A DH spokesman said: “Penalties will be introduced for 2013-14 once progress has been made on validating the backlog data and the NHS has had time to adjust to working to the new standard.”
In the meantime it is “expected” that NHS organisations will act to improve the situation and their attempts will be performance managed by the DH. It is understood the DH believes the absence of a specific contract clause does not prevent local discretion in the use of such a clause by commissioners.
Health minister Paul Burstow said the need to tackle long waiting times was one of the core new standards introduced in the operating framework. He added: “But the fact is that many trusts have a large backlog of patients so we are giving the NHS time to clear it before we introduce fines for those who still have them.”
HSJ columnist and waiting list consultant Rob Findlay said not introducing the contractual penalties “fundamentally undermines the government’s stated intention to reduce the number of patients ‘forgotten’ on English waiting lists”.
“For all the government’s fine words, the new contract retains the penalties that punish trusts for treating lots of long-waiting patients, and creates no new incentives for them to achieve short waits,” he added.
The move was condemned by patients’ and clinicians’ groups.
Patients Association chief executive Katherine Murphy said: “The DH said they would tackle the issue yet instead of taking action they have just stuck to the same targets which have not helped these forgotten patients.
“These targets have produced perverse disincentives meaning that once a patient has waited for longer than 18 weeks, there is no push to make sure they receive treatment as soon as possible after that.”
A Royal College of Surgeons spokeswoman said: “Waiting over a year for non-clinical reasons is unacceptable.
“The system, and the way trusts are measured, should not distort waiting lists – government needs to provide the right incentives to remedy this and ensure patients’ clinical needs are put first.”