By Richard Johnstone | 29 April 2014
MPs have called for an external audit of NHS waiting times in England after finding that differences across the country made it difficult to compare the wait faced by patients at different hospitals.
Examining the wait for elective care in England, the Public Accounts Committee said the Department of Health was unable to be sure existing data was accurate, as hospital trusts use different rules to count waiting times.
Although the introduction of an 18-week waiting time limit in 2008 had driven improvements across hospitals, differences in data-collection practices risked undermining public confidence in whether hospital trusts had met their targets, committee chair Margaret Hodge said.
‘Trusts are struggling with a hotchpotch of information technology and paper-based systems that are not easily pulled together, which makes it difficult for trusts to track and collate the information needed to manage and record patients’ waiting times,’ she added.
The committee highlighted the National Audit Office found waiting times for nearly a third of cases it reviewed at seven trusts were not supported by documented evidence, while a further 26% were simply wrong.
Multiple organisations, including hospital trusts, clinical commissioning groups, Monitor, the NHS Trust Development Authority and NHS England have some responsibility for quality assurance of waiting times, MPs found. However, the external audit undertaken by the Audit Commission until March 2010 has not yet to be replaced ahead of the watchdog’s abolition, the NHS waiting times for elective care in England report stated.
This independent check needs to be re-introduced, Hodge said. ‘Waiting list data needs to be independently audited.
‘The NHS England guidance on the management of waiting times is complex, allowing trusts some flexibility in how they manage patients’ waiting times. There are, however, unintended consequences, such as variations between trusts in the number of cancellations they allow patients to make before referring them back to their GP, thereby restarting the waiting time clock. These differences reduce the comparability of trusts’ waiting times.’
The DoH must work with NHS bodies to agree both responsibilities and a timetable for obtaining assurance about waiting list data, the committee concluded.
Today’s report added the current regime of financial penalties for trusts that do not meet waiting times was not being used effectively. In 2012/13, 80 trusts that had failed to meet at least one of the standards were not fined.
Clinical commissioning groups must agree clear performance improvement plans with trusts which failing to meet targets, Hodge said.
‘Both GPs and their patients need reliable and comparable information about the waiting time performance of individual trusts so that they can make an informed choice about where to be treated,’ she said.
‘Furthermore, patients do not fully understand their rights and responsibilities. It should be a lot easier for patients to interact with hospitals and understand when they will see a consultant, but individual hospital policies on access to treatment are often out-of-date and not publicly available.’
Responding to the report, a spokesman for NHS England said: ‘The NHS has made hugely significant progress for patients since the introduction of the 18-week referral-to-treatment standard.
‘It is clearly critical that we measure progress using the most accurate data that we can. We therefore welcome this helpful report from the Public Accounts Committee, which builds on a report on the same issue from the National Audit Office.’
