Recovery Watch: The 20 trusts with three quarters of the NHS's two year waiters

NHS England is quietly confident the service is on track to hit the major target to eliminate two-year waiters by July, with some significant caveats (explained below). But, nonetheless, there still remains lots to do to get certain trusts over the line. Recovery Watch this week examines the trusts with the most to do on this key metric.

National picture: cautious optimism

There were 14,975 patients who had been waiting 104 weeks or more as of the week ending 3 April, according to the most up-to-date publicly available figures. And system leaders are increasingly confident they will meet the target of clearing the two-year waiters by July – except for a group of between an estimated 2,000 and 3,000 patients.

Ian Eardley, NHSE’s joint national clinical director for elective care, told an internal webinar for NHS leaders last week the numbers were moving “quite nicely in the right direction” and he was “relatively optimistic” the target would be achieved.

The group which will wait longer is quite a broad church of patients, ranging from patients who themselves want to push back their procedures, to various, more complex procedures. He said the most impacted specialties were “one or two specialist areas of surgery, largely spinal, little colorectal, bit of hepatobiliary, little bit of other sorts of orthopedic surgery”.

It is worth flagging there have been warnings that much of the recent drop in two-year waiters has been down to a data blip caused by the fact we are roughly two years on from the first covid lockdown, which saw very few referrals into the NHS, so that dip is now feeding through into how many 104-week breaches there are. This was examined in depth in the last edition of Recovery Watch.

But whatever the reasons, it remains the case that a large proportion of the problem is concentrated in a relatively small number of trusts.

There are 20 trusts that account for over 75 per cent of the total (11,392). And over 50 per cent (8,239) are patients on the lists of just 10 trusts (see table below).

Many, but not all, these trusts are very large. But they will still be the focal areas for NHSE’s elective recovery team, led by Sir Jim Mackey, over the coming weeks. Here is a selection of trusts to keep an eye on. 

Manchester: Still pledging to hit target

Manchester University Foundation Trust, the NHS’s largest trust on turnover, has around 10 per cent of the entire national total (1,491).

Its size does not entirely explain its challenged position, as it was still one of the most challenged performers when taking 104-week waiters as a proportion of overall referral to treatment list size at the start of March.

The data showed that 1.4 per cent of incomplete RTT pathways had waited over two years, the sixth highest in England on this ratio in the country (You can see a table of this metric here).

Of course, this does not make the trust “the sixth worst trust” in the country. It’s nearly impossible to compare waiting lists because of the differing demographics, case mix complexity and resources.

But, all that said, with 10 per cent of the total being overseen by one trust, the performance of MUFT will be critical to success or otherwise of the system as a whole, so no doubt NHSE will be keeping close tabs on progress here.

The good news however, is that the trust is pledging to hit the target. Its May board papers said: “Focused actions over the next quarter will reduce this number significantly down to 0 by the end of June.”

Leicester: Off trajectory

University Hospitals of Leicester, another very large provider, has the second highest total of two-year waiters in absolute terms – and also the second highest total in terms of a ratio of its overall list size.

The trust is forecasting it will have 240 two-year breaches by the end of June (See graph on p.39 of the performance report).

It told Recovery Watch, however: “We expect to return to zero 104 week waiters during the second quarter of 2022-23.

Birmingham: Unclear

University Hospitals Birmingham has the third highest number of two-year breaches in absolute terms. The trust refused to comment about whether it was on target, in contrast to several of its peers which said they were on trajectory. Either way, the sheer volume of risk makes UHB one to watch.

Lancashire: Highest proportion of two-year waiters 

Lancashire Teaching Hospitals accounts for 5.3 per cent of two-year waiters . But perhaps more concerningly, it had the highest ratio of two-year waiters as a proportion of its overall RTT list at the start of March.

The trust declined to comment on whether it would hit the target.

Devon: Off trajectory

Devon is having serious problems with its long waiters, as exclusively revealed by HSJ last week. The integrated care system, one of the most challenged in England, estimates 860 patients will have waited longer than two years for planned care by July 2022.

Around three quarters of the current two-year waiters in Devon are due to be treated by Royal Devon University Healthcare FT and University Hospitals Plymouth, which are the ICS’s two largest trusts.

UHP said it expected it would still have 549 patients cases by June 2022. RDUH, responded after this piece was first published. The trust said it expected to have 354 two-year breaches by July but that it would have cleared all of them by “September, at the latest”. 

Hull: Off trajectory

Hull University Teaching Hospitals Trust has the ninth highest number of cases in absolute numbers. It says it is not on track to meet the July target and expects to have around 160 two-year breaches by then. The trust has, however, agreed a trajectory with commissioners to hit the target by December 2022. The trust said it was on track to meet the revised trajectory.

Rest of the top 10: On trajectory

University Hospitals of North Midlands Trust, Norfolk and Norwich University Hospitals and Countess of Chester Hospitals all said they were on trajectory to hit the July target. Clearly, there remains an element of risk in all their positions due to the sheer volume, but so far so good for this group.