The national elective waiting list hovered just below 3 million throughout the autumn – in defiance of the seasonal pattern seen in recent years – in one of the clearest indications so far of the pressure on the acute sector.
The latest NHS England data shows the waiting list decreased only slightly between August and December, bucking the trend in recent years for it to fall sharply at this time of year. However, the list – which shows 2.88 million people waiting for treatment in December – may have been artificially deflated because three trusts in London did not report their statistics due to IT problems.
HSJ’s projected figure for the real waiting list in December is 2.94 million – the same as the officially recorded high point for 2013 in August. To obtain this we took the official figure and added on the last recorded positions of the three missing trusts – Whittington Health; Barking, Havering and Redbridge University Hospitals; and Barnet and Chase Farm Hospitals – which had been amended in line with national trends. A spokeswoman for NHS England cautioned against projections when no data was available.
- Leader: Celebration and caution over waiting lists
- Rob Findlay’s waiting times analysis blog
- Case studies: waiting lists for sexual health and plastic surgery
Waiting list expert Rob Findlay warned the current performance indicated that the NHS as a whole could breach targets for the proportion of patients who start their treatment within 18 weeks. “Unless something can be done to hold down the number of patients on the waiting list – and there is no sign of this happening – there is now a significant risk that 18 weeks will be breached at national level during 2014,” he said.
The official December waiting list total was a 12.3 per cent increase on the same month in 2012. The number of patients referred by GPs grew by 3.3 per cent over the same period.
Mr Findlay, the founder of Gooroo and a blogger for hsj.co.uk, said the pattern over the previous three years had involved the list growing by about 250,000 from December to August and then falling over the rest of the year.
He said: “What happened last year was that it grew as usual in the first part of the year but then the shrinkage wasn’t as great as usual in the second part of the year, so we started 2014 with a much bigger waiting list than usual.”
Last year’s waiting list rise was accompanied by 186,000 fewer patients being treated in comparison to the year before, with an overall figure of 13.9 million treatments in 2013.
Nigel Coomber, director of NHS Interim Management and Support’s intensive support team, said this reduction in treatments could be due to “financial constraints” hitting trusts. He said: “Some of the things that they might have been able to do in 2012 – [such as] put on extra sessions to treat more patients - may be less available to them now.”
The overall figure for patients treated masked an increase in admitted patients being treated, with last year’s figure being a record. However, the number of patients who were not admitted being treated was at its lowest since 2008-09.
Nuffield Trust research analyst Holly Dorning said it was to be expected that referrals would grow due to “an ageing population, more complex conditions and increasing expectations”.
Homerton University Hospital Foundation Trust medical director John Coakley said: “We’re dealing with all the pressure that we’ve got. The total number of people waiting for treatment isn’t so much of a problem really, it’s whether you can cope with it and I think most places are.”
Mr Coomber said that despite the waiting list growth many trusts have been able to “absorb increases”. He said: “It doesn’t matter to me as a patient whether there’s 3 million patients waiting nationally or 1 million; what matters to me is how long I’ve waited.”
While there has been an increase in the amount of patients waiting for treatment at a national level trusts seem to be coping with the demand.
However, performance deteriorated slightly against NHS England targets that 90 per cent of admitted and 95 per cent of non-admitted patients are treated within 18 weeks. During December, 91.5 per cent of admitted patients and 96.8 per cent of non-admitted patients started treatment within 18 weeks. In comparison, the respective figures for December 2012 were 93.1 per cent and 97.7 per cent.
Far fewer patients are waiting over 52 weeks for treatment – 317 patients compared to 1,085 in 2012. This comes after NHS England imposed £5,000 fines on trusts for each affected patient.
Case study 1: sexual health
The NHS England referral to treatment annual report for 2013 said the reduction in non admitted patients was in part due to sexual health treatments no longer being included in the data. These made up 7 per cent of all referrals.
However, this data was not included in the waiting list because most sexual health treatment tends to take place well within 18 weeks. “Taking that work out of referral to treatment measurement means that it had no, or very minimal impact, on incomplete pathways but it had a reasonably significant impact on reported activity,” Mr Coomber said.
Case study 2: plastic surgery
Consultant plastic surgeon Peter Budny, communications officer at the British Association of Plastic, Reconstructive and Aesthetic Surgeons, said that the increase in patients waiting for plastic surgery treatment could be due to “increasing challenges in terms of cuts to resources, decreased capacity and diminished bed availability relative to need”.
He said some reconstructive procedures undertaken on patients with congenital differences, cancer, trauma and burns were seen as “increasingly a core demand”.
However, he added: “At the other end of our work spectrum, there exist our procedures of recognised value to individual patients which have been targeted by funding bodies as low priority. These tend to represent the tail of the figures and the rise in waits.”
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