The need for wider implementation of good practice to manage and reduce waiting lists and times in the NHS in England is highlighted today in a National Audit Office report. In March 2001 some 42,000 patients had been waiting more than 12 months for admission to hospital, and there are large inequalities across the country in the time that people have to wait for treatment. The Department of Health should consider whether underpinning systems for counting who is on the list and how long they have waited need to be improved.
The report, presented to Parliament by NAO head Sir John Bourn, identifies a number of areas where the Department of Health and NHS trusts have taken positive steps to reduce waiting lists and waiting times, but argues that further changes could be made. The Department announced (13 June 2001) that, building on the reduction in waiting lists, the Government and the NHS would now move on to cut waiting times for treatment.
Key findings in the report are:
- The Department is making concerted efforts to reduce waiting lists and lists have reduced. Measures include additional funding, publication of “Your Guide to the NHS”, the publication of guidance and best practice and the use of teams that visit trusts to identify solutions to waiting list issues.
- Waiting lists and times are too long for some patients. Although inpatient and outpatient waiting lists have reduced simultaneously over the last two years, at 31 March 2001 246,000 people had been waiting for admission to hospital for longer than 6 months and, of these, 42,000 had been on the list for more than 12 months.
- There are significant variations across the country. There are large inequalities across the country in the number of people who have to wait longer than six months for admission to hospital.
- Some patients are being treated in a different order to their clinical priority in order to meet targets. For practical reasons there needs to be some flexibility in the order in which patients are treated but the Department have emphasised that it is inappropriate to operate on routine patients in preference to those who require more urgent treatment solely to meet waiting list targets. Twenty per cent of consultants whom the NAO surveyed said, however, that, in 1999-2000, they frequently treated patients in a different order to their clinical priority in order to reduce their waiting list or to prevent a patient waiting longer than 18 months.
- There are misconceptions about what is counted on waiting lists and currently the total time a patient waits (other than for cancer treatment) from being accepted on an outpatient list to being treated is not calculated or monitored. Inherent problems in the systems and procedures mean that the NAO cannot give an assurance about the complete accuracy of NHS waiting lists. In practice numbers at any one time are likely to be overstated because they include people who should have been removed from the list.
- Wider implementation of innovative practices would make a significant contribution to reducing waiting lists and times. The report identifies five key areas of good practice: the way GPs refer patients to hospital; the operation of clinics at optimal capacity, optimisation of the use of operating theatres, improvement in discharge arrangements; and management of the process as a whole. The National Patients’ Access Team has a comprehensive range of work programmes in place and are taking these forward.
Key recommendations are as follows.
- Management of waiting lists. The Department of Health should consider whether trusts should monitor and manage the total time patients wait, and conduct research into why different health authorities have different waiting times. In addition, the Department should review options for keeping patients better informed regarding the times that they can expect to wait.
- Accuracy of waiting lists. NHS trusts should validate waiting lists at least every six months, and they should be given guidance and advice to resolve inconsistencies regarding the treatments and categories of patients to be included on waiting lists.