comment: Inpatient targets look achievable, but outpatient goal may be elusive

Published: 05/09/2002, Volume II2, No. 5812 Page 10

Busy? We bet you are. Activity figures from the Department of Health show that the NHS has responded to the call to push hard and early towards the next set of waiting-list targets with vigour (news, pages 4-5). Increase in inpatient activity may be fractionally below the annual target, but GP referrals are running at a level which suggests the waiting-list goals are achievable.

So far so good. But although the long waits for inpatient appointments are coming down, the total number of patients waiting for treatment stubbornly refuses to fall.

One contributory factor may be that longer inpatient waits have simply been traded for shorter ones. In some cases this is welcome, but obviously it is not a direct solution to reducing the overall number of waiters. And if it means that clinical priorities are being distorted, as some claim, then it is clearly both dangerous and counter-productive.

But many of the hospital managers HSJ has spoken to tell us that they feel on top of inpatient activity. There are exceptions, of course - lots of them: areas in which new technologies stimulate demand or shortages of staff with relevant skills and experience restrict capacity. And there is the crumbling, inappropriate building stock which makes the reconfiguration of services problematic - or next to impossible. As ever, more money, and time to work out how best to use the cash would also be welcome.

Yet despite all this - and with hands firmly grasping the nearest wooden surface - confidence in the increasing inpatient activity is as high as it gets in the NHS.

Unfortunately, the same cannot be said for outpatients. Here, hope replaces confidence, and knowledge of how the situation can be improved is replaced by the promotion of various solutions, either new or untried.

Yes, there are plenty of examples of excellence, and many of them are being shared. But the sheer numbers of outpatient waiters combined with the unstable nature of demand makes the situation far more problematic. The desire to treat patients locally, or as close to home as possible, is also producing new pressures, and the relationship between primary and secondary care is at its most dysfunctional in this area.

Having reached base camp on inpatients, the NHS can now see an ever steeper, more forbidding, peak on the horizon.