Patients are waiting longer for tests and treatment as pressure on NHS grows

BMJ 2011; 343 doi: (Published 18 July 2011) Cite this as: BMJ 2011;343:d4583
  1. Ingrid Torjesen
  1. 1London

NHS waiting lists in England are creeping up slowly and could rise further under the pressure of winter illness and the effects of the required efficiency savings, a leading healthcare think tank has warned.

The second quarterly monitoring report by the King’s Fund, published last week, shows some worrying underlying trends. It points out that in June the proportion of patients waiting more than the 18 week target for inpatient and outpatient treatment in hospital was higher than at the same time last year.

In May 2010 92.9% of inpatients and 98.2% of outpatients were seen within 18 weeks, but in May 2011 these proportions were, respectively, 90.8% and 97.7%.

The report also warns: “The overall trend in median waiting times for diagnostics seems to be gradually upwards.” Department of Health data show that the proportion of patients waiting more than six weeks for results of diagnostic tests rose from 0.65% in May 2010 to 2.7% in May 2011. This represented an increase from 3500 in May 2010 to 16 000 a year later.

John Appleby, chief economist at the King’s Fund, said, “While waiting times remain low in historical terms, the rise against key target measures since this time last year shows how difficult it will be for the NHS to meet the prime minister’s pledge to keep waiting times low as the spending squeeze begins to bite.”

Waiting lists were a “must do” target for the previous Labour government, but the coalition government has taken a more relaxed approach since it came to power in May 2010, quickly scrapping the 18 week target on time from referral to treatment and relaxing the proportion of patients who had to be seen within four hours in hospital accident and emergency departments from 98% to 95%. But with concern about waiting lists growing, the prime minister, David Cameron, has pledged that the NHS will not return to the days of long waiting lists.

The proportion of patients waiting more than four hours in accident and emergency departments in the last quarter of 2010-11 actually fell to 3.43% from 3.51% in the previous quarter. But these are the highest figures since the second quarter of 2004-5 and a substantial increase on the final quarter of 2009-10, when 2.08% of patients waited more than four hours. Performance also varied widely between hospitals. Although 144 trusts reported that less than 1% of patients waited over four hours in the last quarter, 44 trusts reported a proportion of 5% or more and so were in effect in breach of the new target.

Speaking on the BBC Radio 4 Today news programme on 15 July, Chris Ham, chief executive of the King’s Fund, warned that waiting lists could slip further with most trusts trying to make efficiency savings of 6% this year.

Although the proportion of patients waiting 18 weeks may have risen, a health department spokesperson said, “The average time patients wait for their treatment is currently 7.7 weeks, shorter than the 8.4 weeks patients were waiting in May last year.

“Demand is increasing: there were over 100 000 more diagnostic tests in the three months to May 2011 than in the three months to May 2010. But despite the rising number of people receiving treatment in the NHS, waiting times are stable.”

Richard Thompson, president of the Royal College of Physicians, said, “The apparent rise in waiting lists is both worrying for patients and evidence of an underlying cause: the increasing pressures on the NHS in general. The NHS is now creaking at the seams.

“Our members are finding it difficult to cope with the increased demand for urgent care, and this has a knock-on effect on the ability of hospitals to cope with planned diagnostic tests, medical procedures, and surgical operations. Waiting lists could be the first indication that the NHS is not coping with effects of this inexorable rise in demand.”

Richard Vautrey, deputy chairman of the BMA’s General Practitioners Committee, said, “As well as the obvious distress, both emotional and physical, caused to patients by increased waiting times, there are serious clinical issues. There are many situations where the longer a patient waits for the treatment they need, the less likely the chances of the treatment being effective.”


Cite this as: BMJ 2011;343:d4583