HealthPolicyMonitor | Surveys| LSE - GB| 08| Progress on Waiting Times (April-August 2006)

Abstract
Characteristics of this policy
Purpose and process analysis
Expected outcome
References

Abstract

The length of waiting times and, to a lesser extent, the number of people on waiting lists are often used by the media, and hence the general public, as indicators on how well the NHS is performing. Reducing waiting times has been an important ongoing aspect of Government policy for many years. This report is one of a series that details the progress that is being made on waiting times, and covers the period April to August 2006.

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Neue Entwicklungen

Suchhilfe

Characteristics of this policy

Innovationsgrad	traditionell	innovativ
Kontroversität	unumstritten	kontrovers
Strukturelle Wirkung	marginal	fundamental
Medienpräsenz	sehr gering	sehr hoch
Übertragbarkeit	sehr systemabhängig	systemneutral
current previous

Waiting times have decreased since New Labour was first elected to Government in 1997. These decreases were caused by a combination of an increase in NHS expenditures and targets. The decreases have possibly more or less 'flatlined' recently, probably due to capacity constraints, but at least the waits do not seem to be getting significantly longer. It will be interesting to observe the effect of the Government's more recent policies appertaining to competition and patient choice on waiting times in the future.

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Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Stakeholder positions

Given that waiting times do not seem to be getting noticably worse, the media seem to have been pretty quiet about the latest developments. Had waiting times gotten worse, it is likely that the media and thus the general public would have expressed strong dissatisfaction. The Government is quite proud of the trend in waiting times, and often uses the Department of Health figures on this issue as an indication that their NHS polices are 'working', although as detailed in reports 6(2005) and 7(2006), waiting times have probably fallen over the past few years due to targets and extra expenditures, rather than due to the current policy drive towards more competition among providers and more patient choice of provider. Overall, it is very difficult to criticise positive progress in waiting times because this is such a key issue for the media and the public, although some thought leaders do express concern that waiting list targets leads to 'gaming' by providers and the distorting of priorities.

Influences in policy making and legislation

Reducing waiting times is an ongoing aim. The current target is a maximum waiting time of 18 weeks from general practitioner referral to treatment, and as far as I know, this target was 'centrally' decided by the Government, and did not need to pass through any formal legislative process through Parliament.

Adoption and implementation

Clearly, the Government, the local purchasers of health care, and the providers are involved in managing waiting times. As noted in reports 6(2005) and 7(2006), the Government is attempting to shift the emphasis from targets and money and towards the incentives embedded in competition and choice. It is fairly clear that the former strategy 'worked'; it is not yet clear that the latter strategy will work.

Monitoring and evaluation

The Department of Health regularly publishes the latest statistics on waits, and these will be detailed below. The Healthcare Commission does, I think, also monitor health care providers for their performance with respect to waiting times, and those hospitals with excessive waits are probably subject to some kind of official investigation. Satisfactory performance with respect to waiting times is also likely to be a prerequisite for a hospital to attain 'Foundation Trust' status - the attainment of this status gives a hospital greater autonomy over its management and finances.

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Expected outcome

Although there may have been some gaming in the system, the progress on waiting times has on the whole seemingly been quite positive over the past several years, but any further decrease has probably more or less 'flatlined' by now, possibly due to capacity constraints within the system. The latest figures on waits are detailed below (keep in mind that the target wait is a maximum of 18 weeks, there are a total of about 750,000 to 800,000 patients lined up for treatment in each month, and the figures refer to residents in England). The small increases in August might be partly due to such factors as an increase in accidents during the school holidays, and increase in emergencies due to the unusually hot summer etc.

April 2006

Waiting time in weeks	Number of patients
26	144
20	61,2
13	198

May 2006

Weeks of waiting time	Number of patients
26	58
20	48,6
13	198,6

June 2006

Weeks of waiting time	Number of patients
26	42
20	51
13	194

July 2006

Weeks of waiting time	Number of patients
26	46
20	49
13	178,4

August 2006

Weeks of waiting time	Number of patients
26	115
20	51,9
13	187,8

Impact of this policy

Qualität	kaum Einfluss	starker Einfluss
Gerechtigkeit	System weniger gerecht	System gerechter
Kosteneffizienz	sehr gering	sehr hoch
current previous

The extra NHS expenditures and targets were probably successful in reducing waiting times. It is too early to make a judgement on the more recent policies of competition and choice. However, at least maintaining the current waits is, I would venture, a crucial indication of whether any UK Government is serving the NHS well - i.e. if waits were to deteriorate, the media and hence the general public may place a large question mark against the competency of any Government, at least with respect to their health care policies, which is an important electoral concern.

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