Published: 14/10/2004, Volume II4, No. 5927 Page 27

Despite falls in the number of long waiters, meeting the 18-week target will be tough. Roger Taylor explains

Over the last three years the NHS has successfully cut the number of people on very long waiting lists. It has done this by establishing increasingly demanding waiting-time targets and building them into a performance assessment framework that has dramatic implications for the managers of trusts - the freedom of foundation status for the successful and the threat of the sack for those who fail.

The first chart shows the dramatic fall in the number of people waiting more than six months for an operation.

This success has given policy makers the confidence earlier this year to announce an extremely ambitious new target - that every patient should be treated within 18 weeks from the time a GP refers them to a consultant.

This new target will be a far greater test of the new NHS than previous waiting-time targets. The second and third charts illustrate why.

The second chart shows the change in the median days inpatient waiting time from 2002-03 for the 10 operations with the largest waiting lists in 2003. Although there have been sharp falls in orthopaedic operations and a cut in cataract waiting times overall, for the other procedures there has been little change. In some cases, such as hernia repair, the average wait has increased.

Although we have seen a rapid fall in people on very long waiting lists, we have not witnessed dramatic falls in average waiting times for most patients. This is because most people treated in the NHS are already seen within six months. And the pressure to get those who wait longer treated sooner has meant that some of those who would have been treated more quickly have had to wait longer.

The challenge of meeting the new 18-week target is that it combines both the inpatient and the outpatient wait, unlike previous targets which have separately targeted inpatient and outpatient waiting times. In many cases, additional waiting periods for diagnostic tests are excluded from the officially measured waiting times.

To give a sense of the challenge, we have taken a group of common procedures in the NHS. The third chart shows the median inpatient wait for these procedures - the blue bars. The blue line shows the current six-month target. For most of them, the average wait is already under six months.

We have taken the same group of operations and estimated the median days total wait between referral by a GP and treatment - the red bar. The outpatient wait is estimated from trust data for each specialty. There may be some bias here, as it may be argued that those patients who end up having an operation will be more urgent and would therefore have a better than average outpatient wait.

Nevertheless, the figures give an indication of the scale of the task the NHS now faces. The red line shows the target of an 18-week total wait. For the majority of operations the median wait is significantly higher than the target maximum wait.

Roger Taylor is research director of health information specialists Dr Foster.