wait watcher: Despite the upbeat press release, the latest waiting-time data shows progress towards targets is neither fast nor far enough, says John Yates

Published: 06/12/2001, Volume III, No. 5784 Page 31

Once again, the Department of Health has released an upbeat assessment of NHS life.

When issuing the September waiting-time data, it proclaimed: 'Further progress towards reducing waiting times. ' Ministers are still said to be optimistic, and NHS chief executive Nigel Crisp confirmed to HSJ that 'all the evidence shows we are going to hit our targets'.

It is difficult to see how politicians and civil servants maintain their optimism when you look at the movement towards two of the NHS plan's key targets.

These targets, fully endorsed by the government, are to ensure that no-one waits over 13 weeks for an outpatient appointment or longer than six months for admission. Figures 1 and 2 update quarterly 'progress' on that front.

The trend line shown on each diagram indicates the pace required, since the last election, to achieve the target. It is not pessimism but realism to suggest that without radical changes in policy and performance, the 2005 targets will not be achieved.

The failure to reduce waiting times is accompanied by the news that activity for 2000-01 is little changed from the previous year, despite the welcome increase in funding. Given the continuing increase in consultant numbers and the unchanging number of finished consultant episodes, we find that productivity in some of the key specialties continues to fall.

Over the last 10 years the number of FCEs per orthopaedic consultant has fallen by 21 per cent, from 899 to 711 per year. More surgeons employed does not necessarily mean proportionately more patients are being seen.

Consistent pressure to do more teaching, research, audit, management and clinical governance means less time spent on direct clinical activity. All this is directed at improving quality, but at the expense of leaving a significant proportion of patients waiting unacceptably long periods for diagnosis or treatment.

There is a huge gap between ministerial optimism about waiting times, and the views of those who work in the NHS.

How can the opinion of some key surgeons be reconciled with the targets set out in the NHS plan? Professor Charles Galasko, until recently, represented surgeons in the specialty with the largest waiting-time problems.

As he finished his year as president of the British Orthopaedic Association, he said: 'It is important to appreciate that as a profession we cannot deliver the waiting-list times which the government wants by 2005, and that attempts to pressurise consultant trauma and orthopaedic surgeons will result in increased complications, increased litigation, increased costs to the NHS and increasingly low professional morale. '

That is, not only will the targets not be met, but even attempting to meet them will have dire consequences.

Is this just a strong negotiating stance or a more realistic assessment than that of the civil service?

The BOA has called for 'a media campaign, funded and supported by the government to explain to the public why the waiting time for elective orthopaedic surgery will continue to be long, until the expansion we require has been achieved'.

So will politicians and NHS managers adhere to the targets that most patients want, or will they join the BOA in preparing to explain why they will fail to meet them?

If they intend to stick to the targets, a radical re-assessment of current policies and some new ideas will be needed. It is surely time for politicians, managers and surgeons to sit down and negotiate three fundamental issues:

An appropriate level of resources for the catchment population of each trust.

An increase in fixed sessions for direct clinical activity.

An agreed workload for each set of specialists.

If we are serious about radically reducing waiting times by 2005, then negotiation needs to start today, and implementation must start early next year.

Professor John Yates is director of inter-authority comparisons and consultancy at Birmingham University's health services management centre.