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NHS waiting time performance continuing to decline

Elective care waiting list rose to 4.2m in November 2018

The percentage of patients treated within NHS waiting time standards continues to get worse for both elective and cancer treatment, while the waiting list for elective care continues to grow, a report shows.

The National Audit Office (NAO) found that while increased demand and funding constraints affect the entire system, other factors that are linked to declining waiting time performance include NHS staff shortages for diagnostic services, a lack of available beds and pressure on trusts from emergency care.

The elective care standard aims for 92% of patients to be seen by a consultant within 18 weeks after referral. This was last met nationally in February 2016.

In 2012-13, 94% of patients waited under 18 weeks after referral, but by November 2018 this had fallen to 87.3%.

The elective care waiting list grew from 2.7 million to 4.2 million between March 2013 and November 2018, while the number waiting more than 18 weeks grew from 153,000 to 528,000.

During this period, the number of people treated each month increased from 1.2 million to 1.3 million.

Standards for cancer care were introduced to help improve early diagnosis of cancer and cancer survival rates – most of these standards were met until 2017-18.

However, a key standard, that 85% of patients are treated within 62 days of an urgent GP referral for suspected cancer, has not been met since the end of 2013.

In November 2018, only 38% of NHS trusts met this standard and between July and September 2018, 78.6% of patients were treated within this timescale.

The report found waiting time performance varies significantly across England. In 2017-18, the number of patients waiting less than 18 weeks for their elective care varied between 75% and 96% across clinical commissioning groups (CCGs).

For cancer, between October and December 2018, the percentage of patients treated within 62 days following a GP referral differed across CCGs from 59% to 93%.

The NAO also found elective care waiting times standards are being met for some specialties, such as general medicine, but not others such as surgical specialties. For cancer, performance for lung, lower gastrointestinal and urological cancers was significantly lower than other cancers.

Between the 12 months to March 2014 and the 12 months to November 2018, the number of annual referrals for elective treatment increased by 17%. Between 2010-11 and 2017-18, the number of patients referred urgently for suspected cancer increased by 94%.

The NAO said a growing and ageing population only accounts for a relatively small proportion of the increase in referrals for elective care and cancer. For cancer, the major factor is likely to be NHS England’s policy of encouraging more urgent referrals to improve early cancer diagnosis, it stated.

However, the reason behind the increase in elective referrals is less well understood by the NHS, the NAO said.

Constraints on capacity, including lack of finance, staff and beds, is linked with the decline in waiting times performance. The NAO found that there have been persistent staff shortages in diagnostic services and a widening gap between demand for these services and the number of staff working in these areas.

“The NHS’s actions to increase the number of urgent cancer referrals are a positive step,” said Amyas Morse, the head of the NAO. “They have helped to diagnose more patients at earlier stages, leading to better outcomes, even though this has meant that waiting times commitments for cancer care are no longer being met. However, there has been insufficient progress on tackling or understanding the reasons behind the increasing number of patients now waiting longer for non-urgent care.  With rising demand for care as well as constraints in capacity, it is hard to see how the NHS will be able to turn around this position without significant investment in additional staffing and infrastructure.”

David Hare, chief executive of the Independent Healthcare Providers Network, said it is vital that the significant spare capacity in the independent sector is used by local areas to ensure patients can we treated as quickly as possible.