Labour ministers promises on ambitious 18 week maximum wait for surgery
The government's goal to get the maximum wait for a non-emergency operation on the National Health Service down to 18 weeks by 2008 is ambitious. The 18 week process involves moving patients through three stages. From the initial visit to the GP, the patient has to go to a first outpatient appointment, then through any diagnostic tests that are needed and finally on to the operation itself once a decision to admit has been taken.
But an analysis of Department of Health data by the Financial Times shows that the government will miss its target without additional capacity and reform of the way the service operates.
On the health department's own planning assumptions, to achieve a maximum wait of 18 weeks - from the first GP visit to an operation - the average wait will need to be about nine weeks.
That implies something like an average two week wait from GP to the outpatient visit, three weeks for diagnostic tests, which may include scans and investigative pathology, and then no more than a four week wait once a decision is made to operate.
At the moment, no data exists to measure how long that total wait is - chiefly because there are no national data on how long patients wait for diagnostics. In some parts of the country, however, patients can wait 26 weeks or longer for a scan- which would blow the 18 week promise clearly off course.
But published figures show that the average wait for an outpatient appointment is currently almost 7 weeks - more than three times longer than the two weeks that it will need to be by 2008.
That figure has been falling, down from 7.7 weeks in 2000. But it is falling so slowly that on current trends it will take 35 years to get down to an average two-week wait.
The longest waits for an in-patient operation have also been falling.
But in order to eliminate the relatively small tail of very long waits (more than six, 12 and 24 months) has meant that paradoxically, the average wait patients have faced at the time they get an operation has been going up in recent years, not down.
Since March 2000, the median wait for an operation has risen from 6.1 weeks to 7.4, a 20 per cent increase, when it needs to fall to an average of about 4 weeks if the overall 18-week target is to be met.
And while extra MRI scans and other forms of diagnostics are being installed in the NHS and bought from the private sector, health economists say there is good international evidence that the first effect of that may well be a rise in demand as patients who would not now be sent for a scan because the wait is so long become eligible for one.
In other words, the extra capacity could initially produce little or no fall in the overall wait for some forms of diagnostics, and possibly even an increase.
"What these figures show," according to Alan Maynard, professor of health economics at the University of York, "is that of the three elements needed to get to the overall 18-week target, one is falling far too slowly, one is unknown but may well rise before it falls, and the third - the time spent on the waiting list before an operation - is actually going in the wrong direction.
"Unless something changes radically, the government is going to miss its target".
To hit it will require "an unprecedented increase in productivity", he said, when, on most measures, NHS productivity has been falling as large parts of the extra spending have gone into pay.
Professor Maynard said: "For both the consultants' and GPs' contracts there has been a big increase in pay but no matching increase in productivity.
"There is an argument to be had about whether the NHS needs to buy extra capacity from the private sector over and above the amounts already planned.
"But it clearly needs to organise services much more efficiently if it is to have a hope of hitting the target."
The scale of the challenge is underlined by figures showing that to cut the NHS waiting list by 250,000, the service has undertaken more than 31m operations since 2000. In other words, the 14 per cent rise in non-emergency operations in six years has chiefly gone on keeping pace with demand, not cutting waiting lists or average in-patient waiting times.
That may imply that extra capacity is needed from the private sector, above the contracts announced but not yet advertised, for a second round of treatment centres.
Chris Ham, professor of health service management at the University of Birmingham, said: "The big risk is around diagnostics, where there is a real danger that as more becomes available demand will rise to fill the gap.
"But it is also clear that outpatient services need a major redesign - getting rid of inappropriate follow-up appointments, getting specialist GPs and physicians to do more outpatient work outside hospital, and thus freeing up more time in hospital for first outpatient appointments."
Planning figures released by the Department of Health in September suggest a 10 per cent shortfall by 2008 in the number of outpatient appointments, a potential 10 per cent shortfall in operations, and up to a 19 per cent shortfall in scans and other diagnostic procedures.
The longer-term trends, however, suggest that those figures are an underestimate.
http://news.ft.com/cms/s/66f7c620-7cc6-11da-936a-0000779e2340.html
But an analysis of Department of Health data by the Financial Times shows that the government will miss its target without additional capacity and reform of the way the service operates.
On the health department's own planning assumptions, to achieve a maximum wait of 18 weeks - from the first GP visit to an operation - the average wait will need to be about nine weeks.
That implies something like an average two week wait from GP to the outpatient visit, three weeks for diagnostic tests, which may include scans and investigative pathology, and then no more than a four week wait once a decision is made to operate.
At the moment, no data exists to measure how long that total wait is - chiefly because there are no national data on how long patients wait for diagnostics. In some parts of the country, however, patients can wait 26 weeks or longer for a scan- which would blow the 18 week promise clearly off course.
But published figures show that the average wait for an outpatient appointment is currently almost 7 weeks - more than three times longer than the two weeks that it will need to be by 2008.
That figure has been falling, down from 7.7 weeks in 2000. But it is falling so slowly that on current trends it will take 35 years to get down to an average two-week wait.
The longest waits for an in-patient operation have also been falling.
But in order to eliminate the relatively small tail of very long waits (more than six, 12 and 24 months) has meant that paradoxically, the average wait patients have faced at the time they get an operation has been going up in recent years, not down.
Since March 2000, the median wait for an operation has risen from 6.1 weeks to 7.4, a 20 per cent increase, when it needs to fall to an average of about 4 weeks if the overall 18-week target is to be met.
And while extra MRI scans and other forms of diagnostics are being installed in the NHS and bought from the private sector, health economists say there is good international evidence that the first effect of that may well be a rise in demand as patients who would not now be sent for a scan because the wait is so long become eligible for one.
In other words, the extra capacity could initially produce little or no fall in the overall wait for some forms of diagnostics, and possibly even an increase.
"What these figures show," according to Alan Maynard, professor of health economics at the University of York, "is that of the three elements needed to get to the overall 18-week target, one is falling far too slowly, one is unknown but may well rise before it falls, and the third - the time spent on the waiting list before an operation - is actually going in the wrong direction.
"Unless something changes radically, the government is going to miss its target".
To hit it will require "an unprecedented increase in productivity", he said, when, on most measures, NHS productivity has been falling as large parts of the extra spending have gone into pay.
Professor Maynard said: "For both the consultants' and GPs' contracts there has been a big increase in pay but no matching increase in productivity.
"There is an argument to be had about whether the NHS needs to buy extra capacity from the private sector over and above the amounts already planned.
"But it clearly needs to organise services much more efficiently if it is to have a hope of hitting the target."
The scale of the challenge is underlined by figures showing that to cut the NHS waiting list by 250,000, the service has undertaken more than 31m operations since 2000. In other words, the 14 per cent rise in non-emergency operations in six years has chiefly gone on keeping pace with demand, not cutting waiting lists or average in-patient waiting times.
That may imply that extra capacity is needed from the private sector, above the contracts announced but not yet advertised, for a second round of treatment centres.
Chris Ham, professor of health service management at the University of Birmingham, said: "The big risk is around diagnostics, where there is a real danger that as more becomes available demand will rise to fill the gap.
"But it is also clear that outpatient services need a major redesign - getting rid of inappropriate follow-up appointments, getting specialist GPs and physicians to do more outpatient work outside hospital, and thus freeing up more time in hospital for first outpatient appointments."
Planning figures released by the Department of Health in September suggest a 10 per cent shortfall by 2008 in the number of outpatient appointments, a potential 10 per cent shortfall in operations, and up to a 19 per cent shortfall in scans and other diagnostic procedures.
The longer-term trends, however, suggest that those figures are an underestimate.
http://news.ft.com/cms/s/66f7c620-7cc6-11da-936a-0000779e2340.html
posted by Dr Search- Principal Consultant at the Search Clinic at
8:50 AM
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