NHS backlogs and waiting times in England

NHS backlogs and waiting times in England
NAO 1 December 2021

• This report looks in detail at backlogs and waiting times for elective and cancer care in the NHS in England. It explains how the current increased backlogs and waiting times have arisen, including the impact of the COVID-19 pandemic.
• The report sets out:
• how waiting times performance for elective and cancer care are tracked in the NHS, and how long patients have been waiting relative to the performance standards;
• the causes of increasing longer waits before the pandemic and the disruption caused by the pandemic; and
• the steps the Department and NHSE&I have already taken to address the increasing backlogs and waiting times, and the constraints and challenges the NHS faces in making a full recovery.
• The NAO intends to follow this report with a second one, which will describe the NHS’s plans to improve this situation and evaluate its early progress.

Waiting lists are inevitable. It's how we manage them that matters.

Waiting lists are inevitable. It's how we manage them that matters.
Healthwatch 8 November 2021

• The COVID-19 pandemic has created a huge backlog of people waiting for a diagnostic test or treatment. Healthwatch have spoken to more than 2,500 people about their experiences, helping us to dig beneath the headlines and support the NHS to make good policy decisions on how best to manage waiting lists.
• The report discusses current waiting lists, cancellations, patient experience around waiting for care, interim support services and solutions. The report includes a number of recommendations.

Perioperative care - "preparation lists"

Centre for Perioperative Care

• CPOC is a cross-specialty collaboration dedicated to the promotion, advancement and development of perioperative care for the benefit of patients at all stages of their surgical journey. CPOC produces guidance as an aid to support health care professionals in perioperative care. CPOC guidelines encompass the whole perioperative pathway and include recommendations for each distinct area across the perioperative journey. See the guidelines, useful resources and case studies here.

To tackle the backlog, we need to transform how we wait for surgery [Editorial]
BMJ Opinion 15 April 2021

• “We must get better at supporting patients who are waiting for their surgery to be ready for the NHS when the NHS is ready for them. And, in turn, we need to support healthcare teams to be ready for the patient. Or as colleagues have put it, we need to turn “waiting lists” into “preparation lists.” Changing waiting lists to preparation lists will improve patient outcomes and quality of care, while also helping to achieve NHS Long Term Plan efficiency and transformation aspirations. 
• The Centre for Perioperative Care (CPOC) is working with a wide range of organisations to provide resources and support for clinicians and managers in the design, development and implementation of innovative approaches to deliver quality perioperative care.

Turning ‘waiting lists’ for elective surgery into ‘preparation lists’
British Journal of Anaesthesia January 2021 v126(1) p1-5. DOI:https://doi.org/10.1016/j.bja.2020.08.021

• “There is an inevitable period of time between diagnosis of an illness that may be amenable to surgery and admission for elective surgery. It is now acknowledged that this time can be better spent in preparing patients for surgery in order to improve the patients' experience of healthcare (including quality outcomes and satisfaction), improve population/public health, and reduce the per capita costs of healthcare.”

Number of people waiting over a year for treatment

Number of people waiting over a year for treatment
Nuffield Trust 15 July 2020

• Chart showing the rise in the number of people waiting for treatment by specialty January – May 2020.

What matters to people using A&E

What matters to people using A&E
HealthWatch 20 February 2020

• To inform NHS England's Clinical Review of Standards national polling and interviews have been conducted with patients in A&E which indicate that while the length of someone’s visit is important, people are more interested in the overall quality of care on offer at their local hospital.
• Quality of experience is shaped by diverse factors including communication, staff attitude, the speed of initial assessment, the facilities within A&E departments and whether people feel other parts of the NHS are working together with the A&E department to provide joined-up care.

The four-hour NHS waiting time target saves lives - government should think carefully about changes

The four-hour NHS waiting time target saves lives - government should think carefully about changes
IFS 17 January 2020

• "All of this suggests that the four-hour target has played an important role in improving A&E care. Waiting times have fallen, and while costs have increased, this has been accompanied by large reductions in mortality among high-severity patients. On this basis, the current target appears to be working well for patients – at least when hospitals are broadly meeting the standard."

Clinically-led Review of NHS Access Standards - progress report

Clinically-led Review of NHS Access Standards
NHS England 31 October 2019

• This is a progress report on the review of NHS access standards in urgent and emergency care, mental health services, cancer care and elective care. It
• 1. recaps on the proposed new standards in each of the four areas, the rationale for those proposals, and update on what we are finding through testing.
• 2. sets out the planned next steps in terms of continuing with testing and
• 3. outlines the timetable for making final recommendations and implementing any agreed new standards.
• "For urgent and emergency care, where the field testing has been running longer and will be able to conclude sooner, the intention is to support the NHS to implement any changes from 1 April 2020. For elective care and cancer, implementation is likely to be during mid 2020/21. In mental health, where completely new standards are being proposed, implementation will be to a longer timeframe, as testing is likely to continue in 2020/21 to ensure that the introduction of standards in these areas is sustainable. All timelines are subject to change and government agreement."
• The review is working in tandem with the National review of access to general practice services in England

State of Care - CQC Annual assessment of health and social care

State of Care
CQC 15 October 2019

• In their annual assessment of health care and social care in England CQC looks at the trends, shares examples of good and outstanding care, and highlights where care needs to improve.
• Particular issues highlighted affect people with a learning disability or autism, or mental health issues, waiting times for GP appointments, elective care or cancer, A&E waiting times and stability of the adult social care market.
• "In many cases, crises could have been averted if local health, care and education services had worked in unison to provide an integrated package to support them when they were young."
• "Most of the care that we see across England is good quality and, overall, the quality is improving slightly."
• But people do not always have good experiences of care and they have told us about the difficulties they face in trying to get care and support. Sometimes people don’t get the care they need until it’s too late and things have seriously worsened for them."
• "The challenge for government, Parliament, commissioners, national organisations and providers is to change the way services work together so that the right services are being commissioned to deliver what people need in their local area."

NHS waiting times for elective and cancer treatment

NHS waiting times for elective and cancer treatment
NAO 22 March 2019

• This review presents data on the NHS’s performance against current waiting times standards for elective and cancer care in England, and some of the factors associated with that performance.
• " It is hard to see how the NHS will be able to recover its position on waiting times in the near future without significant investment in staffing and infrastructure."

Report conclusions

Understanding new models of integrated care: a systematic review

Understanding new models of integrated care in developed countries: a systematic review
Health Services and Delivery Research v6(29) August 2018

• A systematic review of the research literature on new models of care identified three outcomes in which the research was more in agreement: (1) that new models may increase patient satisfaction, (2) that staff believe that the quality of care is improved and (3) that new models may increase patient access to services. 
• There was some suggestion that patient waiting time and the number of outpatient appointments may be reduced. The research studies did not agree regarding outcomes such as length of stay in hospital, numbers of admissions and appointments and whether new models might increase or reduce the cost of health-care provision.

See NIHR signal Ways of integrating care that better coordinate services may benefit patients

Plain English Summary

NHS pressures – future trends

NHS pressures – future trends
BMA 30 October 2017

• BMA projections indicate that millions more patients will be waiting for longer than four hours for treatment in A&E, and there will be dramatic rises in the number of people waiting on trolleys for treatment, or at home for non-emergency elective procedures.
• The projections are based on analysis of admissions and waiting times data published by NHS England between 2010 and 2017.

Health Equity Indicators for the English NHS

Health Equity Indicators for the English NHS
Centre for Health Economics, University of York, January 2016

• This analysis of trends in retrospective analysis of socioeconomic inequalities of primary care access, quality and outcomes in England 2004/2005 and 2011/2012 found that investments in GP services led to improved healthcare across all socio-economic groups, particularly among the poorest, between 2004 and 2011. However there was only a modest reduction in inequality in preventable deaths and admissions through A&E.
• The research measured the relationship between social inequality and (1) patients per family doctor, (2) primary care quality, (3) inpatient hospital waiting time, (4) emergency hospitalisation for chronic ambulatory care sensitive conditions, (5) repeat emergency hospitalisation in the same year, (6) dying in hospital, (7) mortality amenable to healthcare and (8) overall mortality. 

Overview of waiting time and patient choice policies

NHS maximum waiting times and patient choice policies
House of Commons Library Briefing, 16 September 2015

• Maximum waiting times
• Patient rights to maximum waiting times
• Pledges on waiting times
• Mental health services
• GP appointments
• New cancer waiting time commitments
• Patient choice
• Shared decision making
• Choice of provider 
• Transferring to a different hospital
• Seeking a second opinion
• GP services
• Personal health budgets
• Mental health services
• Treatment in another European Economic Area country
• http://researchbriefings.parliament.uk/ResearchBriefing/Summary/CBP-7171