Intended for healthcare professionals


Long NHS waiting times are harming patients, MPs warn

BMJ 2019; 365 doi: (Published 12 June 2019) Cite this as: BMJ 2019;365:l4184
  1. Matthew Limb
  1. London

Patient suffering is being overlooked as NHS performance against waiting time targets for cancer care and non-urgent care continues to “spiral downwards,” a report by MPs has warned.1

The Public Accounts Committee said that national NHS bodies seemed to “lack curiosity” and to understand little about how longer waits can harm patients.

Published on 12 June, the committee’s report found that less than half of NHS trusts and foundation trusts currently met the 18 week waiting time standard for elective treatment, and only 38% met the 62 day standard from referral to treatment for cancer patients.

Doctors’ leaders and health analysts backed the committee’s concerns that worsening waiting times were “unacceptable” and said that control must be restored.

The committee chair, Meg Hillier, said, “The impact of protracted waiting times cannot be ignored. As one charity told us, the wait for cancer testing is ‘agonising.’

“Ultimately, NHS England must steer waiting times standards back on course to prevent further decline. We call on the NHS to outline and commit to a firm timescale and plan for delivering this.”

Elective care and cancer referrals

The committee added that the waiting list for elective care had grown by 1.5 million since March 2013, rising to 4.2 million in November 2018.

The target for elective procedures is that 92% of patients should wait no more than 18 weeks for treatment from the date of their referral, but the NHS has not that standard for since February 2016. In November 2018 only 44% of NHS trusts and NHS foundation trusts met the standard.

With suspected cancer, 93% of patients should be seen by a cancer specialist within two weeks of being urgently referred by a GP. In addition, 85% of patients who subsequently have cancer diagnosed should be treated within 62 days of the date of their original referral, normally by their GP.

Since 2013 the NHS has not met the 62 day standard from urgent referral for suspected cancer to treatment. In November 2018 only 38% of trusts met this standard.

From July to September 2018 only 78.6% of patients were treated within 62 days of an urgent referral, down from 83.3% in September to December 2014, when the committee last reported on it.

Hiller said that performance was continuing to “spiral downwards” and that NHS organisations were not being sufficiently held to account in meeting patients’ rights to prompt treatment.

It was troubling, said the committee, that the approach to waiting times by the Department of Health and NHS England seemed to be characterised by “gaps in understanding of patient harm, hospital capacity and what is driving demand.” It said that poorer performance on waiting times was related to bottlenecks in hospital capacity, including diagnostics and bed occupancy.

Mounting crisis

Nigel Edwards, chief executive of the Nuffield Trust, said that the impact on patients was not being taken seriously enough.

“I’m not convinced that just issuing new ultimatums to NHS England will solve these problems,” he said. “It’s all well and good for different parts of government to demand things of each other, but without enough staff and beds the NHS won’t be meeting the old or new targets any time soon.”

Chaand Nagpaul, BMA chair of council, said that deteriorating waiting times were unacceptable and were adding to stress on patients and their families.

He said, “The government must act to address this mounting crisis and listen to the BMA’s call for increased, immediate funding to frontline services, which must include a long term plan that addresses the workload and workforce pressures that are damaging patient care.”

However, NHS England contested the tone of the report. A spokesperson said, “Actually, hard pressed NHS surgeons, nurses, and other staff are treating hundreds of thousands more patients within the current waiting times targets than they did even three years ago, and cancer survival is now at a record high—both facts it is surprising that this report largely ignored.”


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