Flagship waiting time target ‘expected’ to be relaxed

One of the 12 trusts taking part in NHS England’s trial of a new average waiting time elective standard set out its expectations in a board performance report. 

The report, discussed at a Northampton General Hospital Trust board meeting, said: “The target average wait (mean) is expected to be 8.5 weeks from referral although this has not yet been set.”

NHS England confirmed to HSJ that testing was still “ongoing” and no decisions “whatsoever have been made on any particular measure, including a mean wait”.

It follows system leaders setting out their desire to scrap the 18-week target in a report earlier this year by the clinical review of standards group, headed by NHS England medical director Stephen Powis.

The review, ordered by ministers in June 2018, will make final recommendations in March on all the NHS’ core targets, with the four-hour accident and emergency standard also potentially facing the axe.

System leaders said “implementation” of new elective targets was “likely to be during mid 2020-21”, in a progress report published last month, if the trial is deemed successful. Any new targets proposed by the review will be put into the final recommendations report, which NHS England said would be subject to consultation.

Waiting list expert Rob Findlay toldHSJ if system leaders did opt for an 8.5 week average wait proposal, it would represent a relaxation as the current 18-week constitutional standard.

He said there was a close relationship between the current 92nd centile waiting times and mean average waiting times, and that the existing 18-week target equated to an average wait of eight weeks.

He continued: “A target 8.5 week average wait is roughly equivalent to a 92nd centile wait of 19.4 weeks. This is probably a relaxation compared with the current 18-week target, and the government should take flak for lowering standards [if such a target is introduced].

“If the trial evidence shows that clinical priority and fairness have become the basis for booking elective patients, then I may have to admit that the change to average waits is beneficial after all. I fear, however, that one kind of ‘managing to the target’ will simply be replaced by another.”

Mr Findlay has analysed the implications further here: What would an 8.5 average wait target look like?

His exclusive analysis for HSJ also reveals that while 118 out of 183 trusts (64 per cent) were breaching the 18-week target, more would be in breach under the new rules (127 out of 183 trusts – 69 per cent), if an 8.5 average wait benchmark was introduced.

The main reason more trusts are hitting the 18-week target than would be hitting a mean target is because trusts outside the pilot programme vigorously focus on the 18-week target, rather than average wait times.

Full analysis of how every trust is performing against both measures is available in the attached spreadsheet.

Waiting times in England have already reached 24 weeks, a record low performance, with an average wait of 10 weeks. The waiting list has also hit a record high of 4.4 million, according to the most recent official data published this month.

The Royal College of Surgeons said it was supportive of trialling new measures and “open-minded” about potentially changing the target – but only if there was “clear evidence base” that it would be beneficial for patients.

College chief executive Andrew Reed added: “We would like to see the preliminary findings in January so we can see [and] understand what has been tested by the pilots and what the impact has been on patients and waiting times.

“We want to see patients waiting for as little time as possible… [but] until such time there is clear evidence to support a different way of measuring waiting times, it is really crucial to maintain the current standard.”

The former hospital boss added that the college was very concerned about performance against the 92 per cent standard and the record long waiting list.

The Nuffield Trust warned changing to an average wait could be viewed with scepticism by patients.

Nuffield Trust research analyst Jessica Morris said: “There is going to be a challenging PR exercise here if this is introduced. Patients tend to care about how long they are going to wait, not how long everyone else in the queue has been waiting.

“We will want to see it rigorously tested and the results before a decision is made.”

NHS England said in a statement: “Testing and engagement with clinicians and patients on the best measures of short waits for routine care is ongoing, and it is completely untrue to claim that any decisions whatsoever have been made on any particular measure, including a mean wait.”

Northampton General Hospital had not responded to a request to comment on its September board paper at the time of publication.