• UCLH has growing number of patients waiting over a year for elective surgery
  • More are at risk of tipping over 52-week point, with the trust’s commissioner threatening contract penalty notice
  • Trust says its waiting list grew after it moved to Epic electronic patient record system

The number of patients waiting more than a year for elective treatment at a major London teaching hospital has ballooned over the past 12 months.

University College London Hospitals Foundation Trust has 23 patients waiting more than 52 weeks for treatment in October 2019 — up from one in October 2018 — despite NHS England setting the expectation that trusts would cut the number of patients waiting more than 52 weeks to zero by the end of 2019-20.

Although the trust has considerably fewer patients waiting more than a year than some other London trusts — King’s College FT has 184 patients waiting more than 52 weeks, while Guy’s and St Thomas’ FT has 102 — UCLH has had the biggest year-on-year percentage increase in the region. 

UCLH, which was expected to have 30 patients waiting more than 52 weeks by this point in the year, has warned commissioners the number is going to go up before it goes down. It is predicting 20 patients waiting more than 52 weeks by the end of November, with a further 20 “at some risk” of tipping over the 52-week mark.

UCLH and its largest local commissioner, Camden Clinical Commissioning Group, are meeting weekly to discuss the trust’s plans to reduce the number of long-waiting patients after the commissioners wrote to the trust seeking assurance in its management of waits over 40 weeks.

The CCG said, if the trust did not give it that assurance, it may issue a contract penalty notice. The CCG declined to comment on the content of the letter when approached by HSJ because it was prohibited from doing so during the pre-election period before the general election.

Epic

The trust told HSJ it has not received a penalty notice. It moved to a new electronic patient record system in March, called Epic, and saw its waiting list increase after it went live.

“We are still seeing a combination of reporting issues (due to the new system) and real waiting times that have been built up in the early weeks after go-live,” chief executive Marcel Levi explained in his update in the trust’s November board papers. “A lot of focus is directed at 52 weeks waiters with plans in place to have eliminated this at the beginning of next year.”

The trust reported 16 52-week breaches in July 2019 — two in gastrointestinal, 13 gynacology and one in rheumatology — but estimated it would clear the long-waiting patients by the end of the month.

The trust thinks uro-gynaecology and its dental hospital are the key risk areas for further increases. There were 16 breaches in uro-gynaecology due to long-term sickness of core staff and the “limited surgical capacity” of a consultant in its specialist mesh service. The surgeon has a national profile and attracts many referrals.

“Ongoing surgical capacity challenges” meant the specialism still had nine patients waiting over a year for surgery, though the trust said it had a “revised plan to clear 52-week waits ready for the end of November”.

The trust also continues to suffer from a lack of specialist theatre capacity for its paediatric dental service, which has contributed five of the eight breaches at its Eastman Dental Hospital.

18-week target

The number of patients waiting more than 18 weeks for elective surgery has also increased dramatically at the trust. There were 4,307 patients on the waiting list for more than 18 weeks in October 2018. The latest figures show there are now 12,244 waiting 18 weeks or longer.

Its overall waiting list continues to grow, up to 52,617 in October. This is “significantly higher than the March 2020 target of 42,237 patients,” according to the trust’s board papers.

A UCLH spokeswoman said: “UCLH takes the current challenges around waiting times very seriously and is working with commissioners to address the longer waits for treatment that our patients are experiencing in some specialties.

“In October, commissioners asked for regular reports on patients waiting longer than 40 weeks and details of the escalation process for patients at risk of waiting longer than 52 weeks. We have developed action plans to improve performance and have already seen a reduction in waiting times and numbers in some areas.”