We now have referral-to-treatment waiting time data up to the end of March. This despite it being a legal right under the NHS constitution. NHS England is currently undertaking a Clinically-led Review of NHS Access Standards. Part of the additional £20.8bn real-terms funding increase between 2018/19 and 2023/24 is earmarked for reducing waiting times. NHS services were transformed to free up beds and manage the spread of the infection: patients were discharged, planned treatment postponed and services shifted online. Specifically, it looks at what would have been needed – if the NHS were operating within a ‘business as usual model’ – to return to delivering the standard of 92% of patients being treated within 18 weeks, given the waiting lists and waiting times backlog that had built up by January 2020. In January 2020, before coronavirus (COVID-19) began to impact on the UK, more than one in six patients were waiting more than 18 weeks for routine treatment. Meeting the 18-week standard would require hospitals to increase the number of patients they admit by an amount equivalent to 12% of all the patients admitted for planned care in 2017/18. E: mediaoffice@kingsfund.org.uk, Andrew McCracken Even with the positive news of a vaccine, the impact of Covid-19 on waiting times for NHS patients will be felt for years to come. For further information, or to request an interview, please contact the Press and Public Affairs team on 020 7307 2585 (if calling out of hours, please ring 07584 146035). giving a total of £560m more per year at an absolute minimum. Just 46.8% of patients were treated within 18 weeks in July, against the 92% target—the lowest since records began, data from NHS England showed. It is important to note that these estimates may be low – they assume that waiting times have no impact on the rate at which GPs refer patients for specialist care or treatment thresholds in specialist care. Admissions virtually ceased. Returning to ‘normal’ levels of activity is expected to take some time and, even before COVID-19, there were substantial challenges with waiting times. However, the additional measures that will now be needed to deliver planned care – as well as the risk of having to up- and downscale activity to manage local outbreaks of COVID-19 – will present substantial challenges to efficiently managing waiting lists. And international comparisons showed that the UK no longer had some of the longest waits – the median wait for a hip replacement in the UK fell from 215 days in 2001 to 78 by 2008. Our base scenario consists of an additional £380m per year for 4 years to keep pace with demand (200,000 additional patients a year being treated), plus £3.6bn to clear the backlog (1.3 million patients). Management of the Covid-19 crisis has meant an increase in waiting times which we are working hard to reduce. Incomplete pathways are waiting times for patients waiting to start treatment at the end of the month. Covid-19 has dramatically altered how NHS services and finances operate. Waiting times in accident and emergency (A&E) departments are a key measure of how the NHS is performing. Note: Health Foundation analysis of NHS Digital: Referral to Treatment (RTT): 18 Weeks RTT waiting times data following Findlay’s methods and NHS Digital Reference cost data. This gives patients the legal right to treatment within 18 weeks of referral (18 week RTT) and as part of this, pledges that patients should not be required to wait six The total direct cost will depend on how efficiently the NHS deals with waiting lists. The number of patients treated within 18 weeks of referral has fallen by more than half compared with the same time last year, figures show. At the end of April 2020, the NHS in England was asked to begin a cautious programme to begin resuming the routine services suspended in response to COVID-19. Even without COVID-19, reversing the deterioration in performance against the standard would have required ruthless prioritisation alongside years of hard work, investment and reform. Various measures in the NHS Long Term Plan should support more efficient delivery of some of the additional activity needed, but are unlikely to substantially reduce demand. “The total number of patients waiting six weeks or more from referral for one of the 15 key tests is at almost 571,500 — 58.5 percent of the total number of patients waiting … General and acute bed occupancy in England was already at 92.0% – the maximum set by NHS England and Improvement – at the end of 2019 and nursing vacancies were over 40,000. You'll need your: booking reference number. To address this, the coalition added an additional standard for 2012/13 that at least 92% of patients still waiting to start treatment should have waited 18 weeks or less. The 'Start now' button below will open the NHS e-Referral Service booking website: Manage Your Referral. COVID-19 makes the challenge even greater. In 2013/14, NHS England set an operational standard to ensure that no-one waits more than 52 weeks for treatment. In 2002, the Labour government committed to a major injection of NHS funding with one of the key aims being to dramatically reduce waiting times for NHS elective care in England. time from GP referral to first outpatient appointment, time to arrive at a diagnosis and decide on treatment options, and. As the NHS looks to start to recover services, this analysis looks at the context in which planned treatment will recommence. Press and Public Affairs Manager, Harry Dayantis The NHS Strategy Unit has forecast that there will be 1.8 million new referrals to mental health services in the next three years as a result of Covid-19. Receive the latest news and updatesfrom the Health Foundation. Findlay recently pointed out that ‘4 years of waiting list growth would need to be undone to achieve the NHS Constitution standard again’. There have been just under 4 million fewer referrals for hospital care since March this year compared to the same time last year, with more patients having their conditions managed by their GP or in the community. This remains well below the 19.6-week median wait recorded in July 2020. Today the number of patients in hospital with COVID-19 is falling, but many of those discharged will need aftercare and ongoing support for example from mental health, primary and community health services. Even before the COVID-19 pandemic, to meet the 18-week standard for newly referred patients and clear the backlog of patients who will have already waited longer than 18 weeks, the NHS would have needed to treat an additional 500,000 patients a year for the next 4 years. Figure 4 is our estimate of the planned allocation of NHS funding growth. care; there is little prospect of recovery in the foreseeable future. What would it take to recover the 18-week standard? time from that decision to the start of treatment. However, demand for the service has increased significantly over recent years and, although the number of referrals is now gradually coming down, this has led to long waiting times. Long-waiting patients everywhere simply remained on their waiting lists, their waiting times rising by one day, every day. At that point, 92% of patients were being seen within 20.3 weeks rather than 18, and the waiting list was 3.83 million. In the winter of 2017, 8% of patients were waiting over 21 weeks for their referral; this rose to 25 weeks by the end of January 2020, with 4.42 million people on the waiting list. Before we factor in COVID-19’s impact, given the gap between current performance and the standard, what would it take for at least 92% of patients to begin treatment within 18 weeks, how much would it cost and is there a realistic prospect of delivery by 2024? April 2020 saw just over half the number of emergency admissions than the same month in 2019; returning to normal could see emergency patients potentially reoccupying tens of thousands of hospital beds. But even with huge efforts, the reality is that longer waiting times for planned care are likely to be a feature of the NHS in England for several years at least. Until the health service has the capacity it needs to meet demand...a promise to recover 18-weeks within this parliament would be putting the cart before the horse. Table 1: Estimated cost of returning to the 18-week standard. Waiting times have increased in all regions and specialties. Financial penalties for not meeting the 18-week standard were introduced in 2012, which led to more effective prioritisation of cases and management of patient flow. If your cancer referral is from a screening programme, 87% are now left anxiously waiting over two months for treatment. Maximum waiting times for non-urgent referrals The maximum waiting time for non-urgent, consultant-led treatments is 18 weeks from the day your appointment is booked through the NHS e-Referral Service, or when the hospital or service receives your referral letter. Measures of patients' experience in hospital: This paper provides a brief guide to measuring patients' experiences to help trust boards and other interested parties. Shifting from 18 months to 18 weeks required funding, but it also involved significant attention to how patients flow through the health care system from referral, to assessment for diagnostic tests, and onto treatment. How is COVID-19 changing the use of emergency care? This would require hospitals to increase the number of patients they admit by an amount equivalent to 12% of all the patients admitted for planned care in 2017/18. Deborah Ward, Senior Analyst at The King’s Fund, comments on the monthly performance data on A&E, referral to treatment and diagnostics. In April 2019, NHS England introduced a new fine for providers and commissioners to each pay £2,500 per patient that exceeds a 52-week waiting time from referral to treatment. All non-urgent planned acute care was postponed and – following a 57% fall in A&E visits in April 2020 compared to the same month in 2019 – there were concerns about people not getting the urgent care and treatment they need, including for serious health conditions such as cancer. Providing timely care has been a consistent challenge throughout the NHS’s history – and one that Covid-19 has made several magnitudes more difficult. When you book you'll only be offered appointments for vaccines that are recommended for you based on your age, any underlying health conditions, and whether you're pregnant. Gbemi Babalola, Senior Analyst at The King’s Fund, comments on the latest NHS hospital activity figures. We help to shape policy and practice through research and analysis; develop individuals, teams and organisations; promote understanding of the health and social care system; and bring people together to learn, share knowledge and debate. The number of people waiting more than 18 … REAL Centre: making health and care services more sustainable, Improving national health and care policy, Health Foundation and IFS projection modelling. Fundamentally, NHS activity to complete pathways and remove patients from waiting lists has not kept pace with the growth in demand. WAITING lists across the NHS have reached the highest levels since records began due to the coronavirus pandemic. The rates of spending growth, set out in the NHS Funding Bill in February 2020, will not be sufficient to cover the cost of meeting the 18-week standard by March 2024, even before any additional costs and demand arising from COVID-19. NHS England Cancer Waiting Times [vi] First cancer treatments following an urgent GP referral 83% 60% Activity increases to 70% of 2018-19 average (reasonable increase after 2 successive month-on decreases of 21-30%) Activity continues to decrease to 50% of 2018-19 average NHS England Cancer Waiting Times [vi] More about NHS … Long waits may mean patients experience additional pain, anxiety and inconvenience, and may lead to higher risk of harm and poorer outcomes. Some 2.5 million people were waiting more than 18 weeks for operations in July, compared to over 620,000 this time last year. Waiting Times Referral To Treatment (RTT) The current wait times for treatment are available by clicking the link below. People at higher risk. For the backlog, following Findlay’s methodology, this analysis has increased the average cost by 50% on the basis that these cases will be more complex and, therefore, more costly to treat – leading to an average cost of £2,800 per patient. Even with the positive news of a vaccine, the impact of Covid-19 on waiting times for NHS patients will be felt for years to come. RT @BecksFisher: General practice in areas of high deprivation is under-funded and under-doctored relative to need. The system of Payment by results rewarded trusts for expanding elective activity, and being on track to hit 18 weeks was a prerequisite for applying for coveted foundation trust status. This can be quantified through the index of waiting list management, a measure of how effectively hospitals are allocating their resources and how quickly the NHS can treat a given list of patients. This analysis therefore presents the activity and cost implications of meeting the 18-week waiting time standard if the index returns to 2011 levels. This may also have capital funding implications in order to provide enough beds and physical facilities. And, in January 2020, before COVID-19 began to impact on the UK, more than one in six patients were waiting for more than 18 weeks. This results in a higher cost of recovering the 18-week standard of £6.8bn. This section contains information on Consultant-led Referral To Treatment (RTT) waiting times, which monitor the length of time from referral through to elective treatment. In total, around 7,700 patients are waiting for longer than 18 weeks between referral and treatment. It is also highly possible that the cost of the recurring additional activity is higher than the estimated average; here the recurring costs have been inflated to match the backlog clearance (£2,800). In recent years, patients have been waiting longer in A&E; here we look at why that is. Referral to treatment waiting times statistics for consultant -led elective care for April 2019 ... NHS England Published ... (COVID-19) Coronavirus … Responding to the latest NHS performance statistics, David Maguire, Senior Analyst at The King’s Fund, said: ‘Today’s statistics suggest that the backlog for care is worse than expected, and the 162,000 people waiting more than a year for care are only the tip of the iceberg. Despite the best efforts of hard-working staff, there simply isn’t the capacity to get through the backlog quickly. ‘The NHS went into Covid-19 with a workforce crisis and rising waits for care. Returning NHS waiting times to 18 weeks for routine treatment 3 . By January 2020, the number waiting more than 18 weeks increased nearly threefold to 730,267 in 4 years, while the waiting list has grown from 3.35 million to 4.42 million – and probably more, with several trusts not currently reporting data. What is more interesting is the likely impact of the covid-19 shutdown on the very longest RTT waiting times. To free up NHS capacity, non-urgent planned care was postponed for 3 months from 15 April 2020. Even if the government is willing and able to increase NHS funding by £500m a year over the next 4 years, delivering the additional activity required to recover the 18-week standard is unlikely to be feasible. We estimate the total direct cost of treating 92% of patients within 18 weeks to be £5.2bn–6.8bn, including elimination of the backlog by the end of March 2024. Delivery of waiting times was also hardwired into system reforms to enable patient choice and competition. We don’t know how many more people will need urgent or routine care next year as a result, but this can only add to the considerable backlog of 4.4 million people waiting for care. NHS patients should be treated within 18 weeks of being referred with the total NHS waiting list now at more than four million. Using the same methodology, Health Foundation analysis estimates that to keep up with this growing demand and meet the 18-week standard for new patients, the number of additional patients the NHS needs to treat each year has increased to 210,000. 'The impact of Covid-19 on waiting times for NHS patients will be felt for years to come': The King's Fund responds to latest NHS performance statistics, Performance against key national waiting time standards has deteriorated in recent years, leaving many people waiting longer for. A few years later, the ‘completed pathway’ standards were dropped entirely and the ‘incomplete pathway’ standard became the NHS’s single measure of elective waiting times. (For example, 36% of patients with incomplete pathways over 18 weeks required an inpatient admission in January 2020.) 21. Reducing elective waiting times from ‘18 months to 18 weeks’ was one of the English NHS' major achievements in the 2000s. This would be an unprecedented increase in activity. Copyright The Health Foundation 2021. Thursday August 27 2020, 12.01am BST, The Times. But this transformation has not been sustained and waiting times are now making the headlines for all the wrong reasons. Figure 1 shows the percentage of patients on the waiting list for over 18 weeks by region in January 2020 – this is compared to the 8% (100%–92%) target. Book or manage your COVID-19 vaccination appointments. Advice for people at higher risk from COVID-19, including older people, … Our estimated cost is £1,800 per patient completing treatment. Under the 18-week standard, the clock starts with a GP referral and only stops when the patient starts treatment or is discharged. The covid-19 elective shutdown began in mid March. And the impact of the shutdown is already very clear. The latest news and opinion from the Health Foundation on the NHS Long Term Plan. decide which measurement and feedback tools are appropriate for their requirements. All specialties but one (geriatric medicine) have missed the target since November 2018. Figure 2 shows the percentage of patients on the waiting list for more than 18 weeks by specialty. 40,000 additional cases at an average cost of £1,800, 175,000 ((1.3m – 600,000) / 4) cases per year at an average cost of £2,800. Press and Public Affairs Manager, Rachel Case This note provides supplementary information and guidance to enable referrals … This would be an unprecedented increase in activity. Please upgrade your browser. This content relates to the following topics: M: 07584 146035 December 2008, but diagnostic waiting times now form part of the NHS Constitution. Alongside the additional funding, in the NHS Long term plan the health service set out a strategy for how to spend the money and improve services. The King's Fund is an independent charity working to improve health and care in England. In January 2020, before coronavirus (COVID-19) began to impact on the UK, more than one in six patients were waiting more than 18 weeks for routine treatment. A typical pathway involves three stages: The 3 and 6 month targets could be met but, with no comparable measure of time spent in the second stage, some patients still experienced long delays. Findlay estimated that the NHS needed to treat an additional 170,000 people per year to keep up with demand and see 92% of new patients within 18 weeks. Our vision is that the best possible health and care is available to all. This figure was based on Findlay’s initial estimates of the recurring pressures and backlog of 170,000 and 600,000 patients respectively. In 2004 this crystallised into the ambition to reduce waiting times from ‘18 months to 18 weeks’. The imperative to keep patients with COVID-19 separate will prevent the NHS from returning to pre-pandemic levels of bed occupancy, which reached 92% by the end of 2019. The Health Foundation estimates that spending growth would need to increase by a further £560m a year – assuming the NHS can prioritise patients to make the most effective use of available capacity. The 2000s were the era of ‘targets and terror’, but delivery took more than performance management. In costing the additional activity needed to keep pace with demand, we calculate a weighted average cost of an inpatient treatment (£4,200) and an outpatient-based treatment (just over £500). The NHS has a “hidden waiting list” of 15.3 million patients who need follow-up appointments for health problems, according to … There will need to be longer term changes in how planned care is delivered and the independent hospital sector could play an important role, after it was virtually block-booked early in the pandemic to provide additional capacity. This analysis estimates that spending growth needs to increase by a further £560m a year unless the extra investment planned for mental health, primary and community health services are scaled back. Over a 6-week period, NHS hospitals in England went from treating no patients with COVID-19 to looking after a daily peak of 19,000 inpatients (confirmed as having the virus) in mid-April. The consequence of this has been longer waiting times for many non-emergency treatments. If the aim is to meet the 18-week standard by the end of this parliament (which this analysis takes as by the end of financial year 2023/24) this would mean the NHS needs to treat over 500,000 more patients in each of the next 4 years. Paper out today on wh…. If this were spread evenly over the next 4 years, it equates to a total annual cost of £1.3bn. It is estimated that up to 14 million dental appointments could have been missed across the UK over the course of the pandemic. Despite the best efforts of hard-working staff, there simply isn’t the capacity to get through the backlog quickly. The average wait for treatment by a hospital consultant rose to 19.6 weeks in July 2020. We look for talented and passionate individuals as everyone at the Health Foundation has an important role to play. By December 2008, waiting times for elective care had fallen substantially: 90.3% of admitted patients and 96.8% of non-admitted patients were seen within 18 weeks. As such, they do not reflect the full scale of the challenge. Introducing the 18-week standard in 2004 fundamentally changed how the NHS measures and manages waiting times. So, even before the COVID-19 pandemic took hold, it was hard to see how the 18-week standard could have been achieved by the end of 2023/24 given the infrastructure and staffing levels. Reducing elective waiting times from ‘18 months to 18 weeks’ was one of the English NHS' major achievements in the 2000s. The government has set out funding plans for NHS England up to 2023/24, showing that spending will increase by £20.8bn in real terms by 2023/24. The standard was last met in February 2016, when the number of patients who had waited more than 18 weeks was 269,589. This is based on the assumption that just over a third of the extra patients requiring treatment each year will need to be admitted to hospital. All financial figures are in 2019/20 terms. The latest waiting times data showed almost 225,000 patients had now waited more than a year for their operations, with the total waiting list at 4.6 million people. But this did not always reflect the reality of how long people waited. The number of NHS hospital beds in England has more than halved over the past 30 years. The pandemic is likely to make waiting lists grow further and the challenge will be even greater. David Maguire, Senior Analyst at The King’s Fund, comments on the latest NHS hospital performance statistics. The numbers above would require almost 2.2 million more outpatient appointments and elective admissions in 2023/24. Returning NHS waiting times to 18 weeks for routine treatment. Nationally procured contracts with the independent sector created additional elective capacity, as well as another incentive for trusts to raise their game and avoid losing lucrative extra income. This. In addition, he concluded that there was a backlog of a further 600,000 patients who would also need to be treated to recover the standard overall. RTT waits should of course be 18 weeks rather than 25 weeks, so an extra week is not going to be particularly noticeable in the grand scheme of things. The number of people being added to the waiting list each year is growing by 3.1% and the NHS is not keeping up with the growth in demand. At the end of April, the NHS in England was asked to begin a cautious programme to resume some of the routine services. Other hospitals have seen similar spikes in waiting times. Since then, waiting times have deteriorated. The standard that at least 92% of patients should wait no longer than 18 weeks to start elective treatment has not been achieved for nearly 4 years.
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