Published: 19/09/2002, Volume II2, No. 5823 Page 21
Is the government on track to deliver waiting-list targets? The evidence is not encouraging, argues John Yates
The June waiting-time figures revealed a mixed picture in terms of the ability of the NHS to meet government waiting-time targets. The number of GP referrals waiting over 13 weeks for an appointment, as expected, bounced back from the very low March figure, but is still below the straightline reduction between the date the targets were announced and the scheduled date of delivery (see figure 1). However, the number of inpatients waiting over six months for admission increased and the NHS is moving further away from the required line of delivery (see figure 2). Are current strategies adequate?
Despite the evidence, with only three years left before judgement day, the spin doctors continue to assure us things are moving in the right direction because the number of very long-wait patients (over 12 and 15 months) is decreasing. They would examine table A and say that in the last financial year there was a large reduction in the 12-month plus figures. Perhaps they will soon realise they are being duped by the NHS, which seems to be admitting long-wait patients at the expense of the shorter waits.
If waiting times are to fall significantly the NHS must:
treat more elective patients than in previous years;
reduce the numbers waiting in all time bands.
A few trusts in England have few or no orthopaedic patients waiting over six months for admission.
Analysis shows that on average they keep the size of their total waiting list to about a quarter of their annual elective workload. If their waiting list is about three months of workload overall, they have the flexibility to adjust waiting times to take account of clinical priorities without huge numbers waiting over six months. The implications for the orthopaedic specialty in England are enormous. Assuming workload remains little changed, the current waiting list of 280,000 needs to fall to 120,000 to sustain waiting times of under six months. This is a far greater task than simply 'knocking off ' the current 80,000 orthopaedic patients who are waiting over six months.
Those who argue that waiting-list numbers are not important may need to readjust their thinking and look at the evidence. Trusts with short waiting times also have short waiting lists in relation to their workload.
Professor John Yates is director of inter-authority comparisons and consultancy at Birmingham University's health services management centre.