The reasons why the 18 week target isn't on solid ground

In November last year, the King’s Fund reported on waiting times standards, trying to track the impact of the extra £250m provided to the NHS in order to improve performance.

‘National waiting time performance was meant to be back on track by the end of the year’

This money was meant to pay for extra activity with two aims: to reduce the number of those on the waiting list who had been waiting a long time, but also – once this group had been taken off the list – to help bring waiting time targets, which had begun to slip, back into line.

Alongside the money came some top level performance management, with Jeremy Hunt chairing weekly meetings with NHS leaders and ministers, including Eric Pickles and Oliver Letwin, underlining the political significance attached to waiting times in general.

National waiting time performance was meant to be back on track by the end of the year so, with the new waiting times data released by NHS England, how have things been?

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Target met

The headline from the latest data is that all referral to treatment performance standards were met in December 2014 – this is a huge success for the NHS.

It’s particularly encouraging that the waiting times target has been met for those requiring an admission to hospital for treatment, as this target had not been met for the previous six months in a row.

The waiting times for outpatients (or non-admitted patients) had missed the target in November for the first time in six years but is now back on track.

‘While all three referral to treatment targets are now being met, it is by narrow margins’

While all three referral to treatment targets are now being met, it is by narrow margins and performance for patients yet to begin their treatment (patients still waiting) actually worsened in December.

Focus on performance standards

Was the NHS also successful in achieving the aim of reducing the number of those waiting a long time?

In his speech in August, announcing the additional activity, Mr Hunt said that the number of patients waiting more than a year to begin their treatment should be “as close to zero as possible”.

When this announcement was made, 532 patients had waited more than a year to begin their treatment; in December this had reduced to 399.

With 207 of these patients (52 per cent) waiting for treatment from just one NHS provider, this does not seem to be a system-wide problem.

‘This does not seem to be a system-wide problem’

Without a clear definition of what counts as “long waits”, it isn’t easy to provide a broader verdict. There was a reduction in the number of patients waiting more than 26 weeks to begin their treatment from the time the health secretary made the announcement, but in the most recent data, this jumped up by more than 9,800 patients.

This might suggest that in December the attention of the NHS switched from reducing the longest wait to hitting the performance standards.

Intractable problem

Does this place the iconic 18 week target on a firm footing for 2015? We think not, for the three following reasons.

First, the number of organisations failing to report their waiting times continues to rise. NHS England estimates that for December, nearly 250,000 patients were waiting in these organisations. This is an alarmingly high number.

‘Once we add lost patients back into the statistics, the waiting list sits stubbornly high at 3.2 million’

Second, once we add these lost patients back into the statistics, the waiting list sits stubbornly high at 3.2 million. Sustaining performance will be challenging against this backdrop, not least when performance is already so close to the wire.

Third, separate data suggests the NHS ramped up (cheaper) day case activity in December by nearly 40,000 over December last year. The number of “ordinary admissions” - admissions that require an overnight stay -actually fell. However, these patients are generally more expensive and more complex to treat and, in some cases, will compete for beds with emergency admissions.

With the NHS under pressure in January as emergency admissions rose, the problem of long waits for this group may prove more intractable.

James Thompson is senior research analyst, health policy, for The King’s Fund