Quality and safety must determine our targets

Rob Findlay’s analysisof issues around the 18-week waiting standard is timely.

Demand pressures are not abating. More activity usually means more payment. Providers across acute, community and mental health are working hard with clinical, managerial and commissioning colleagues to avoid an unhelpful game of pass the deficit parcel within English health economies.

• Rob Findlay: ‘England is stuck with complex and perverse waiting times targets’
• John Appleby: The pros of waiting time targets outweigh the cons

‘We should learn from past NHS waiting list blitzes’

The first point is that clinical quality and safety must drive our decisions. Doing what’s clinically right for patients sets evident challenges to creating any waiting time target, because urgency of clinical needs varies.

The point about varying methods of recording waiting times is fair, but obvious IT technological challenges sit alongside methodological ones. While national standardisation of measurement would have benefits, there is always a debate on how prescriptive (or top-down) the system should be.

Deeper understanding

We should learn from past NHS waiting list blitzes. It is generally accepted that, as primary care colleagues notice waiting time reductions, thresholds to refer to specialist care diminish.

Appleby and Lewis noted that: “A considerable amount of learning – about the nature of the phenomenon of waiting lists and the multi-pronged solutions needed to reduce waiting times – has taken place. Waiting lists are not simply a ‘backlog’ of work that can be cleared given enough healthcare resources. Clinical decisions… are crucial in determining success or failure in reducing waiting times.”

Patients’ choices about the timing of treatment also matter. Mr Findlay notes that 10 per cent choose to delay their admission: a deeper understanding of the area of patient choice and the role of decision-aiding tools might also be helpful.

If changing the waiting time targets is the right approach, then the key challenge is, as Mr Findlay notes, political. Achieving cross-party consensus on such a change would be challenging at any time – even more so in the run-up to a general election.

Chris Hopson is chief executive of the Foundation Trust Network