The government's plans to drive down excessive waiting times stand no chance of success, according to a report from independent social-policy think-tank Civitas.
Achieving the target of a maximum 18-week wait from referral to treatment (RTT) by the end of this year is impossible given the lacklustre performance of some strategic health authorities (SHAs), primary care trusts (PCTs) and hospital trusts, it says
The report Why are we waiting? An analysis of waiting times in the NHS says the interim target of 85% to be seen within 18 weeks by the end of March 2008 is looming and is sure to be missed. The government appears to have already accepted it will not be met, as Health Minister Ben Bradshaw has announced a “10% buffer zone” - in other words the target has come down to 90% by December 2008.
In recent years maximum targets have been put in place at all levels of the NHS – 48 hours to see a GP, four hours to be seen in A and E and 18 weeks from GP referral to hospital treatment.
While many of these targets have been largely met the report details evidence of 'gaming': doing what is necessary to meet the target rather than what is best for the patient. The most notorious example of this has been the practice of keeping patients in ambulances until A and E departments are confident of being able to treat them within four hours of admission.
The government has now realised that the only long-term solution is not targets but choice and competition, the report says. But this will be prevented from being achieved by GPs unwillingness to provide the necessary information to patients because of a misplaced desire to protect inefficient local healthcare system, including the nearest hospital.
The report's author James Gubb, director of the Civitas health unit said: “It must now be down to PCTs and GPs to encourage choice and competition to ensure the window of opportunity that has been provided isn't missed. For the benefits of competition to be realised, and for waiting times to really accelerate downwards, the reluctance of commissioners to use independent providers at the expense of established NHS providers has to change - and fast.”
The report points to data showing utilisation of independent sector treatment centres is below capacity, despite all the evidence pointing to better standards of care, and that just 45% of GP referrals are made using the Choose and Book system, which is necessary to access the benefits of competition.
John Appleby, chief economist of the King's Fund said: “Commissioners appear to be analytically underpowered and nervous about destabilising existing provider networks, and they behave as if they want to revert to central control and provider protectionism.”