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Government may leave some patients out of 18 week target

BMJ 2007; 335 doi: (Published 15 November 2007) Cite this as: BMJ 2007;335:1015
  1. Adrian O'Dowd
  1. Margate

    The government may adjust its 18 week target for treatment by the NHS in England so that it does not apply to all patients, a health minister said last week.

    The target of guaranteeing patients treatment within 18 weeks of being referred by their GP, first announced in 2004, is due to be met throughout England by December 2008.

    The health minister Ben Bradshaw, however, has now said in a radio interview that a “clarification” of the target was needed, to mean 90% of patients.

    Some patients may be “clinically justified” in waiting longer than 18 weeks for treatment, he said on BBC Radio 5 Live, to allow hospitals a “buffer zone” and to enable clinicians to take account of individual patients' needs.

    The Department of Health confirmed that it is looking at a threshold for meeting the target of 90% of patients who require hospital admission and 95% of those who do not.

    The latest figures show that 76% of outpatients were being treated within 18 weeks in August 2007, along with 56% of inpatients—up from 48% in March this year.

    The department said that the threshold for the 18 week target should be set below 100% to allow for patients for whom delays are necessary because of the nature of their illness and for those who want to wait longer for personal reasons.

    Mr Bradshaw said that no patient would have to wait more than 18 weeks for treatment unless they chose to or it was essential to delay their treatment for clinical reasons. He was confident that the target would be met by all trusts by December of next year.

    Jonathan Fielden, chairman of the BMA consultants' committee, said, “We have been pushing for a move away from the pure target culture. A possible 10% buffer zone will allow trusts to move the focus from purely finance to quality, and ease some of the pressure to meet the politically set 18 weeks target.”

    Doctors strive to meet targets, he said, but added, “That means you don't necessarily allow the best for a patient or you get people just meeting the target and looking for ways to get around the time rather than looking at the whole process to improve care for the patient.

    “Patients should be seen as quickly as clinically appropriate—that's what the measure should be, rather than a particular time buffer, but having 10% will help. What we really need to see is a change away from this time target culture to one of quality.”

    The Liberal Democrat health spokesman, Norman Lamb, said that people would be sceptical about this change. “Ministers will struggle to convince a public already sceptical about government statistics that this change isn't merely providing political cover because of fears they will fail to achieve their target.

    “This seems like yet more shifting sands over waiting times. Why is this key target being changed now? Many people will smell a rat.”

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