Daily Insight: Some reflection, same direction

Sir Jim Mackey admitted this week that NHS England “forgot the people” when it published controversial guidelines last month saying patients faced being removed from the waiting list if they declined two appointment dates, as we reported.

The NHSE elective recovery chief said the guidance, the existence of which was exclusively revealed by HSJ, was drafted to address legitimate concerns from trusts, but that the process had been “rushed”.

He told the King’s Fund annual conference that NHSE would “spend time” better understanding patients after “reflecting” on the process which had created the controversial guidelines.

Sir Jim’s candour was welcome. But NHSE told HSJ the guidance, which had sparked widespread criticism including from patient groups, would not be changing.

So, where does that leave the NHS managers in dealing with the cohort of patients the guidance was designed to address, ie those offered multiple appointments but continually decline them or simply don’t turn up.

As the guidance remains valid, trusts may well opt to implement a “two strikes and you’re out” policy. But some trust chiefs have privately told HSJ they are simply not prepared to go down this route.

In short, this ethical and operation challenge remains a live issue which has not been satisfactorily addressed by the central guidance. And some, including HSJ columnist Rob Findlay, remain convinced NHSE must reconsider the guidance.

Now you see it, now you don’t

OK, it’s not magic really… But NHSE has revealed it estimates there are 5.5 million people on elective referral to treatment waiting lists, rather than the 7 million which is often reported.

No figures have previously been given for the number of separate individuals, but many in politics, policy and the media have often indicated it is the same as the total number of entries on the RTT list – which hit 7 million in August (and yes, HSJ has been guilty of this too).

NHSE elective recovery chief Sir Jim Mackey, speaking at the King’s Fund annual conference in London yesterday, revealed the estimate for the first time of the number of individuals.

Sir Jim said: There are around a million and a half people, we think, who are on multiple times [some because they require more than one procedure and others are duplicates]. So, it’s a lot more complicated than we all think.”

Of course, aside from the genuine duplicates, this does not reduce the number of procedures required to be carried out by the NHS, but the distinction between people on the list and procedures required is an important one.

NHSE is carrying out a piece of work to try to add further to clarity to what is still a very messy, complex picture.