By Richard Johnstone | 23 January 2014
Financial pressures faced in the NHS mean it is ‘an increasing challenge’ to meet the 18-week waiting time target for treatment across England, auditors have warned today.
The National Audit Office also said the health service was being hampered by flaws in waiting time data and inconsistencies in the way that patient referrals to hospitals are managed.
Today’s NHS waiting times for elective care in England report stated the introduction of an 18-week standard by the Labour government in 2008 led to more patients being treated in the timeframe. This called for 90% of patients admitted to hospital and 95% of other patients to have started treatment within this period.
The strengthening of the standards by the coalition government in April 2012 to ensure it applied to patients still waiting for treatment also initially led to ‘a rapid and significant effect on reducing the numbers of people waiting a long time for treatment’, auditors stated. The number of people each month waiting longer than 18 weeks fell from 234,000 in October 2011 to 138,000 by the end of October 2012.
However, the number rose to 169,000 by the end of October 2013. The report found that 58 trusts breached the standard in at least one month of 2012/13 for patients admitted to hospital.
In addition, the NAO said it has identified errors in the way waiting times were recorded. Although the rules have been set at a national level, the performances of individual trusts are not directly comparable due to local variations in how and when each patient’s waiting time ‘clock’ is started, paused or stopped.
The NAO’s review of a sample of cases found individual errors in trusts’ recording of patients’ time – in 167 cases, there was evidence of at least one error, leading to both under- and over-recording of waiting time.
Auditor general Amyas Morse said the challenge of sustaining the 18-week waiting standards was increasing against a backdrop of a £20bn efficiency drive across the health service and an increasing number of patient referrals.
‘If this challenge is to be met, then performance information should be reliable,’ he added. ‘However, we have found significant errors and inconsistencies in how trusts record waiting time, masking a good deal of variation between trusts in actual waiting times.
‘The solution is not costly new processes, rather making sure existing processes work properly and are properly scrutinised.’
Responding to the report, Bill McCarthy, NHS England’s policy and strategy director, insisted tremendous progress had been made since the introduction of the 18-week referral to treatment standard.
‘More than a million patients are treated by the NHS each month with over 91% of them starting their treatment within the 18-week target and around half of these patients only wait nine weeks or less.’
NHS England would study the reports recommendation to see how waiting time data can be improved, he added.
‘NHS England firmly believes it is essential to have accurate information provided in a timely way to ensure better care for patients. The NAO rightly points out where there are problems with data and these must be addressed.’
