Waiting times targets failing the sickest patients

The King’s Fund is calling on the NHS to ensure that the way waiting time targets are implemented prevents increasing numbers of patients from facing long waits for hospital treatment.

The Fund’s latest Quarterly Monitoring Report (QMR) shows that in January, the number of patients waiting for more than four hours after a decision to admit them to hospital from A&E (trolley waits) rose to 81,003, with 1043 waiting more 12 hours - both the highest on record.

These patients are usually waiting for a bed in hospital and are most in need of treatment.

Patients undergoing routine treatment are also facing longer waiting times. The NHS Constitution gives all patients the right to start treatment within 18 weeks of a referral from their GP. However, in December 2017 12% of people waited for longer than this - the highest percentage since March 2009. The number of patients waiting more than 52 weeks for treatment increased to 1750.

With the four hour target for A&E and 18 week target for routine treatment looking increasingly unachievable, the Fund says that the way the current targets operate is leaving growing numbers of patients facing long waits for treatment. It is calling on the NHS to ensure that those not treated within the time limits do not experience long delays before they are treated.

The Fund’s regular survey of NHS finance directors underlines recent data highlighting worsening finances among NHS trusts. It also highlights increasing financial difficulties for local commissioners, with more than a third (36%) expecting to overspend their budgets this year, the highest proportion since we began surveying them. This suggests the Department of Health and Social Care may yet struggle to stay within its spending limits, despite the additional NHS funding announced in the Budget. The report also finds that:

  • Nearly two-thirds (63%) of finance directors felt that patient care has worsened in their local area in the past year. Just 4% said it had improved
  • More than half (52%) of Trust finance directors said they expected their organisation to end 2017/18 in deficit. A third (32%) were fairly or very concerned about meeting financial targets agreed with national NHS bodies
  • Demand for services continues to soar - admissions from A&E jumped by 6.8% in January 2018 compared to January 2017, reaching 389,649
  • More positively, progress on reducing delayed discharges from hospitals has continued to improve, with 145,318 total days delayed in December 2017, the lowest total since September 2015.

Richard Murray, director of policy at The King’s Fund, said: “Waiting time targets are failing some of the patients most in need of emergency care. Our latest quarterly monitoring report underlines the heroic efforts of NHS staff to keep care standards high in the face of unprecedented pressure on services. But the way waiting times are designed means that there is very little protection for people who can’t be treated within the initial time limit.

“With demand for services likely to remain high, it’s very unlikely that meeting these targets will become more achievable. The waiting time standards should not be abandoned but the NHS needs to ensure the way they are implemented does not leave patients who are not treated within the time limits facing long waits for treatment.”


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