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Elective waiting times grow, audit report shows

Poor waiting times linked to staff shortages

Jo Carlowe

Friday, 22 March 2019

The waiting list for elective care continues to grow, according to a National Audit Office (NAO) report, published today.

The NAO report* also shows that while the NHS has increased the number of people it treats each year, the percentage of patients treated within waiting time standards continues to get worse for both elective and cancer treatment.


The NAO has 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.

In addition, the NAO notes that two in five compensation claims were due to delays in treatment or diagnosis, and warns this figure could rise if patients continue to be left on long waiting lists.

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 of cancer care targets were met until 2017-18, the report found. 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.

Waiting time performance varies significantly across England, the report shows. 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%.

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.

The NHS’s inability to keep up with the growing number of referrals means that more people must wait longer for their treatment after being referred, the NAO notes. For the majority of months since April 2013, the NHS has treated fewer elective care patients than the number of patients referred.

“Constraints on capacity, including lack of finance, staff and beds, is linked with the decline in waiting times performance,” states the NAO.

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.

Despite increasing bed occupancy rates, the number of beds in the NHS has reduced by 7% (8,000) since 2010-11.

“While reducing excess beds may create efficiencies, after a certain point the capacity challenges this will introduce will impact on other resources such as staff and theatre usage,” the NAO states.

In conclusion, the NAO recommends that NHS England and NHS Improvement set out how they will address declining waiting time performance, and do research to better understand variations in performance, the impact of delays on patients and how performance is related to hospital capacity constraints such as bed capacity, and its links to other variables such as staff numbers and theatre usage.

Amyas Morse, head of the NAO, said: “The NHS’s actions to increase the number of urgent cancer referrals are a positive step. 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.”

An NHS England spokesperson told OnMedica: “The NAO is right to highlight improvements to NHS cancer care, which mean more people are surviving cancer than ever before, and that despite significant increases in demand, more people are getting quick tests and hospital treatment.

“As the additional funding to help deliver the NHS Long Term Plan becomes available from April, local health groups are being allocated the money they need to increase the amount of operations and other care they provide, to cut long waits.”

Responding to the findings, a Department of Health and Social Care spokesperson said: “We thank the NAO for the report and will be responding to their detailed findings in due course. Through the NHS Long Term Plan we will back the NHS with an extra £33.9bn a year by 2023/24 which will help grow the amount of planned surgery year on year, cut long waits, reduce the waiting list and guarantee the future of our health service."


NHS waiting times for elective and cancer treatment. National Audit Office, 22 March 2019.

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