What happened to waiting times in May? Reporting on the newly-released referral-to-treatment (RTT) waiting times for England, The Guardian said:
Number of cases missing waiting time target of 18 weeks since GP referral soars by a third
:
Waits rise ‘leaves NHS struggling to cope’
:
More patients waiting longer
:
Rise in long waits for treatment shows you can’t trust Cameron to keep NHS promises
Even the Department of Health said, rather defensively:
We are committed to keeping waiting times low. There are more people than ever before in the healthcare system.
Crikey. It sounds like a real bloodbath. So what actually happened?
If you want to look at the detail, you can download all the data in our waiting times fact checker here:
RTT_waiting_time_fact_checker-May_2011.xls
First, here’s the trend for the total number of patients waiting, charted to bring out the seasonality:
Total list size (English incomplete RTT pathways)
The number waiting went up, but no more than it did last year. No evidence of big trouble there, then. How about the long-waiters?
England time trend for long-waiters
The dotted line shows how long the top 10 per cent are waiting, if you look at patients who are still on the waiting list. Things have continued to improve since the winter, and long-waits are at their best since June 2010. And the number of very-long-waiters, still languishing on the list a year after referral, is down to 12,530, which is 12,530 too many but still the best performance ever recorded (it was 18,458 at the time of the election). No evidence of trouble there either.
What about the solid line? That shows how fast the NHS is clearing the backlog of long-waiters, and therefore isn’t really a measure of waiting time pressures at all. Nevertheless the Government perversely intends that it should be below 18 weeks, which it is, so no problem on the official figures either.
Where, then did these dreadful headlines come from?
The Guardian article says:
A total of 27,834 patients in England who received inpatient treatment in May 2011 had waited more than 18 weeks for it since being referred by their GP, compared to 20,504 in May 2010 – a year-on-year rise of 33.5%.
The Guardian don’t have the numbers quite right, but they’re close enough for our purposes. They are referring to the number of patients admitted as inpatients or daycases, who had waited more than 18 weeks since referral (adjusted admitted pathways). And these are indeed up by over 33% on the previous year.
Does that mean that waiting times are up? Not at all. It means the NHS admitted more long-waiters, and cleared some backlog. If we rewrote that sentence, looking at patients who are actually still waiting instead (and being a little less selective about the data points), it would read:
A total of 224,870 patients in England who are still waiting at the end of May 2011 had waited more than 18 weeks since being referred by their GP, compared to 276,871 in February 2011 – a drop of 18.8%. However this is more than in May 2010 when only 209,411 were waiting more than 18 weeks – a year-on-year rise of 7.4%.
So how should we sum up the latest data? I’d say that things got steadily worse between the time of the election and the depths of winter, and have steadily improved since then. As the underlying pressures on the waiting list have eased, the Government’s preferred measures have followed a few months later.
There is an important caveat, though. Around the country, patients are being kept away from the waiting list with various rules about eligibility for treatment. We cannot know how many are affected. All we can say, is that the reported figures don’t tell the whole story.
In a post tomorrow, I’ll report on the detail at Trust level.
