• Board papers for joint committee of five CCGs said acute providers were “now working” to a 40-week referral to treatment targets – in contrast to the constitutional 18-week wait standard.
  • STP said its “delegated budget is not sufficient” to meet waiting times standard
  • CCGs and trust now indicate they are not abandoning the 18-week standard.

A group of NHS organisations have said they are “working to referral to treatment time targets of 40 weeks instead of 18 weeks”, in board papers which they are now indicating are misleading.

The clinical commissioning group joint committee for mid and south Essex received a report saying its three acute trust providers were “now working to [referral to treatment targets] of 40 weeks instead of 18 weeks to reduce the risk of 52-week [wait] breaches”. 

December board papers said the move was “to reduce the risk of 52-week breaches, as agreed with commissioners”. The NHS Constitution is supposed to guarantee patients will receive treatment for elective procedures within 18 weeks of referral — less than half the period given by the Essex organisations.

The papers for the joint committee’s previous meeting, in October, said the same thing.

The five CCGs told HSJ in a statement that the two sets of board papers referred “to a targeted approach agreed with commissioners to reduce the waiting times for those patients who are yet to be treated”.

“This is alongside continued work to support meeting the 18-week standard and we all remain committed to ensuring patients in mid and south Essex are treated as quickly as possible,” the statement said.

Clare Panniker, chief executive of Mid and South Essex Hospitals Group — which oversees the patch’s three acute trusts — said in a separate response to HSJ“We are working to the national 18-week RTT standard like the rest of the NHS and are working tirelessly to treat our patients as quickly as possible.”

The hospitals cover a population of 1.2 million.

The joint committee board paper from December, said: “The number of 52-week breaches had deteriorated significantly over the previous month.” In August across the sustainability and transformation partnership, 111 patients had waited for longer than a year for treatment, and this had risen to 160 by the end of September, the latest data available. Overall 67,544 patients were waiting for treatment as of September 2019.

The actual waiting time figures could be higher as Mid Essex Hospital Services Trust, one of three acute trusts on the patch, has remained off national reporting since December 2017 due to problems implementing a new IT system. The other two trusts are Southend Hospital Trust and Basildon and Thurrock University Hospitals Foundation Trust. All three are planning to merge by April 2020.

Budget not sufficient

The board papers also said returning to the 18-week standard could cost the system £4.5m and its “delegated budget is not sufficient to achieve constitutional standards”.

It warned of an “increasing risk” of further 52-week breaches until ”additional capacity becomes available/affordable” and that long waits could result in “potential patient harm”.

The news comes as NHS England is considering changes to the national RTT standards, which one local board paper suggested would mean a move to an “8.5 week mean waiting time”. The proposal, which will not be finalised until March 2020 if at all, has been criticised by experts as a “lowering of standards”. 

It is not clear if Mid and South Essex acute trusts’ RTT target has been signed off by NHS England and NHS Improvement. HSJ has approached them for comment. The board papers said the system was in meetings with the centre over MEHT returning to reporting.

The board paper also revealed it would cost the system approximately £3m to avoid significant 52-week breaches before the end of 2019-20 and up to £1.5m per acute site to clear the backlog. It said this financial position could worsen if NHS England imposes waiting time fines on the system, as suggested by national guidance.

The CCGs also warned outsourcing further work to the independent sector to tackle waiting times could result in the CCGs and the STP as a whole “breaching control total[s]” and could cause “disinvestment in other services”.

The CCGs’ joint committee October board papers also reported “that offering choice at 26 weeks is a CCG responsibility, but [is] not currently implemented”.

It is not clear if the system is now offering that choice but the STP said if patients chose to use another provider this would also increase the risk of breaching the area’s acute budget.

The December paper said “the increase in cancer two-week referrals, plus the increase in A&E activity appears to be impacting RTT performance due to limited bed capacity”. It said the system was reviewing capacity in six RTT priority areas, including dermatology and ophthalmology. It has approached independent sector providers in the area to ascertain what capacity they have to help clear the RTT backlog.

It also said the “MSE [acute trusts have] submitted a plan (showing activity and financial investment required) to commissioners and regulators to mitigate 52-week breaches risk”.

Ms Panniker also said: “A substantial increase in demand for emergency care has impacted our ability to improve our elective performance. With resources needed to care for the additional 3,900 emergency inpatient admissions we have dealt with this year compared to last, it has been difficult to create the necessary additional capacity to treat elective patients.

“Reducing waiting times for our patients is one of the key drivers behind our decision to merge, enabling us to reconfigure our clinical services. By separating our elective and non-elective care we know we can improve performance and patient experience”.

The five CCGs in the STP are Thurrock, Southend, Basildon and Brentwood, Mid Essex, and Castle Point, Rayleigh and Rochford.

Correction: This article was updated at 10:43 on 10 December to correct a typo