The NHS’ efficiency drive is already beginning to damage hospital waiting times, according to the King’s Fund think tank.
Its research found the need to achieve £20 billion of efficiency savings was increasing the difficulty of managing demand for services, meeting targets and maintaining quality.

Nearly 15% of hospital inpatients waited over the 18-week period the Labour government had made its target for treatment in February 2011 – the highest level for nearly three years.

Patients waiting over four hours in accident and emergency was up to its highest level since 2004/05, but the proportion of patients waiting more than six weeks for diagnostic services fell back in February.

“This report will provide a regular health check on the state of the NHS as it comes to terms with the new financial climate and implements the government’s reforms,” King’s Fund chief economist John Appleby said.

“It highlights significant concern among NHS finance directors – who are well placed to report on the stresses in the system – about the prospects for the year ahead.

“With hospital waiting times rising, the NHS faces a considerable challenge in maintaining performance as the financial squeeze begins to bite.”

The first instalment of the report found that nearly half of its panel identified ward closures and cuts in services as among the main ways of meeting productivity targets in their area.

David Flory, deputy chief executive of the NHS, said the health service had had a good year in spite of last year’s “exceptionally cold winter”.

He pointed out that average waiting times remained low and broadly stable and that the NHS had a healthy financial surplus “in line with its plans”.

Mr Flory added: “Despite continued good performance, the NHS is still facing pressure from growing demand and will do so for many years to come.

“This particular snapshot shows that the NHS must maintain its focus on waiting times and improving patient outcomes, while dealing with the extra demands on the service.

“Under the government’s modernisation plans, patient choice and transparent information will increasingly drive improved performance in the NHS.”

Health secretary Andrew Lansley’s proposed reforms of the NHS, which would create a market dynamic based on GP consortia being handed the bulk of commissioning powers, remain deeply uncertain, however.

Massive opposition from NHS workers, culminating in a no-confidence vote in Mr Lansley from the Royal College of Nursing earlier this month, has forced ministers to pause the health and social care bill’s progress through the Commons as the government embarks on a ‘listening exercise’.

From: http://www.politics.co.uk/health/hospital-waiting-times-highest-in-three-years

Hospital waiting times have begun to rise again after years of decline following the introduction of European rules on junior doctors’ working hours.Waiting times in the NHS had been dropping since the 1990s but the rules limiting junior doctors to a 48-hour week, which were implemented last August, had reversed the trend.

Thousands more patients were now waiting longer than 18 weeks for surgery because of eu red tape.

Ministers were seeking to renegotiate Britain’s position on the European Working Time Directive, including a possible opt-out for NHS staff. The Royal College of Surgeons carried out the first comprehensive analysis of how the directive had affected waiting times.

According to the research, the proportion of NHS patients having to wait longer than the 18-week target for non-emergency surgery such as hip replacements had almost doubled from 1.5 per cent 18 months ago to nearly three per cent in March this year.

Waiting times reached an all-time low at the end of 2008, with patients waiting just a few weeks for surgery on average.

However, since the EU directive cut junior doctors’ hours from 56 to 48 per week, these gains had been wiped out, the Royal College said.

According to data from the Department of Health, the number of patients waiting longer than 18 weeks — from GP referral to being treated as an inpatient — fell steadily from April 2007, when almost 34,000 people were waiting, to 8,674 in December 2008.

The figure remained stable at about 10,000 until June 2009, just before the new rules came in, when the rise began.

In March this year, it had risen to 17,515, a level last seen in September 2007.

John Black, the president of the Royal College of Surgeons, said the increase was predictable.

“If you have the same number of patients, no more doctors and ask them to work less then it is inevitable that the time available for elective procedures will reduce and waiting lists grow,” he said.

Almost two thirds of consultants now frequently operated without assistants because departments were so stretched.

Mr Black said most European countries had bypassed the legislation by either not monitoring compliance or, as in Germany and Holland, finding ways around the directive.

“We look forward to this happening in the UK,” he said.

Sir Richard Thompson, the new president of the Royal College of Physicians, said the directive had been a “complete disaster” for both patient care and the quality of training for doctors.

“We are not providing the service or the training that we require,” he said. “I cannot overemphasise the damage to service provision and to training.”

According to the survey, 80 per cent of consultant surgeons and two thirds of surgical trainees said patient care had deteriorated since the directive was implemented.

Dr Matt Jameson-Evans, a spokesman for Remedy UK, a junior doctors campaign group, said the impact of the directive on services was inevitable.

“Patients are simply not being treated by as many doctors as before,” he said. “A second consequence of this and equally important is that doctors are not receiving as much training as they were and this has serious implications for the future quality of care.”

The Royal College of Surgeons has argued for an opt-out to allow trainees to work up to 65 hours per week because they were not getting enough practical experience on a 48-hour week.

The Coalition has abolished the 18-week target, saying it was not backed by evidence that it benefited patients.

Dr Mark Porter, the chairman of the British Medical Association’s consultants committee, said the drive for cuts within the NHS was also a factor in the rise in waiting times.

From: http://www.telegraph.co.uk/NHS-waiting-lists-rise-after-doctors-hours-cut

NHS Hospital waiting times have been relaxed or scrapped as part of a drive by the new Government to rid the NHS of Labour’s ‘target culture’.

Nursing and doctors’ leaders welcomed the greater flexibility they have been given to treat patients according to clinical need rather than being forced to stick to strict central guidelines.

But patients’ groups expressed concern that the reforms could result in a “free-for-all,” and that without targets long waiting times could return to the NHS.

GPs will no longer be forced to see patients within 48 hours of them seeking an appointment.

The requirement for 98 per cent of patients attending Accident and Emergency wards to be seen within four hours has been relaxed to 95 per cent.

And the target for patients to be given a hospital appointment within 18 weeks of being referred by their GP has been abandoned altogether.

Andrew Lansley, the Health Secretary, insisted that people would still have the right to demand high levels of service from the NHS, but that this would be done locally rather than dictated from the centre.

“I want to free the NHS from bureaucracy and targets that have no clinical justification and move to an NHS which measures its performance on patient outcomes,” he added.

“Doctors will be free to focus on the outcomes that matter – providing quality patient care.”

Katherine Murphy, director of the Patients Association, said: “The targets focused minds in the NHS, made people start realising services had to get better.”

But Dr Laurence Buckman, Chairman of the BMA’s GPs Committee, welcomed the relaxation in targets.

He said: “Patients should have good access to GPs. However, while this target may have been intended to improve access it has in fact had adverse consequences.

“At the moment practices need to have enough appointments available on the day or the following day to meet the target, so those who want to book in advance find there are fewer appointments available.”

Under the changes to the NHS Operating Framework, Mr Lansley has also ordered health bodies to reduce management costs from £1.85 billion to £1 billion by 2013.

While spending on the health service will continue at current levels, he said it was crucial to make “immediate” savings which could be reinvested in patient care.

From: http://www.telegraph.co.uk/NHS-waiting-times-are-relaxed-and-abandoned