Waiting times improved in June, but the underlying waiting list pressures kept growing as activity remained short of demand, says Rob Findlay

England’s referral-to-treatment waiting times improved from 23.0 to 22.4 weeks in June, not because the NHS suddenly started keeping up with demand (in fact the waiting list size broke new records), but because admission rates perked up and the shape of the waiting list tightened.

However there was bad news at the ultra long waiting end of the waiting list, because the number of one-year waiters grew for the first time in 12 months.

In the following discussion, all figures come from NHS England and NHS Improvement. If you have a national statistic that you’d like to check up on, you can download our RTT waiting times fact checker.

England-wide picture

Headline waiting times improved by four days nationally, down from the end of May peak.

01 92pc of waiting list

The list of non-reporting trusts did not change in June. If their last known positions are added back in, then the waiting list topped 4.5 million patients for the first time since records began.

02 non reporting trusts

Returning to the reported numbers, the waiting list size ticked up to a new record, and three years of waiting list growth would need to be reversed before 18 weeks became achievable again.

03 waiting list in England

The index of waiting list management, which bundles up the influences on waiting times other than list size, improved sharply in June and moved closer to the levels seen between 2012 and mid 2017. This is a good thing, but improvements in the waiting list shape can only be banked once, meaning that further significant gains on this measure are less likely.

04 index of waiting list management

The admission rate improved to the highest June value since 2016. In the long run, keeping up with demand and shrinking the waiting list is the only way to achieve sustained improvements in waiting times, and this is particularly important at the longer-waiting, heavier end of the casemix where patients need to be admitted for treatment.

05 admissions per working day

After a year of improvements, the number of one-year waiters started to edge up again. These ultra long waiters are concentrated at just six trusts, with the largest number waiting at King’s College Hospital Foundation Trust.

Across England, two-thirds of one-year waiters are found in just three specialties: orthopaedics (29 per cent), and “other” plus general surgery (37 per cent) – I have lumped the last two together because much of “other” is subspecialties separating out of general surgery.

06 one year waiters

The longer surgical waits (which rely more on admissions) generally improved in June, while the shorter medical waits generally became longer. Only geriatric medicine is achieving 18 weeks at national level.

07 92pc of waiting list by specialty

Local detail

The proportion of local services (specialties within trusts) that are achieving 18 weeks edged down to just 50.1 per cent. We are very close to the point where achieving 18 weeks is a minority sport.

08 services within 18 weeks 50_1pc

The distribution of waiting times converged slightly on 18 weeks, in line with the specialty picture above, as moderate waiting times increased and some of the longer ones improved.

09 distribution of local service waits

Waiting times at University College London Hospitals FT have increased from 25.3 to 27.4 weeks during June, propelling the trust some 22 places up the table of longest-waiting providers and earning it a place in the top 20. Their waiting list has grown sharply, and they comment in their July board papers that “This growth is partly due to data quality issues, reduced clinical activity in early April and reduced validation effort in April and May following the Epic launch.”

10 top twenty

Referral-to-treatment data for July is due out at 9:30am on Thursday 12th September.

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