Let’s take a closer look at the April waiting time stats just released by the Department of Health for England. (An overview, and interactive maps showing the pressures at all English Trusts, have already been published here.)

By specialty

All surgical specialties improved, England-wide, except for Cardiothoracic Surgery. Here are the time trends:

Specialty trends

By Trust

The real variation appears when you drill down to Trust level. In the following time-series, each English Trust admitting over 50 patients in the month is represented by two points: a blue one showing how many weeks 90 per cent of patients were admitted within, and a red one showing how many weeks 90 per cent of patients still waiting had waited within. Each monthly chart is sorted, so that the red (still-waiting) points rise continuously.

http://www.youtube.com/watch?v=Wc6pg50mzCo

The final chart in the series is this one:

April 90th centiles by Trust

If you watch the blue dots in the video you will see that something interesting is happening. Towards the right of the chart, where Trusts have the greatest pressure from patients who are still waiting, the blue dots have gone up in the last few months. That means these Trusts are admitting more long-waiters, in an effort to tackle their waiting time backlogs (even though that looks bad on the admission-based targets). This is a very welcome development that will improve waiting times in the long run.

If we plot the red and blue dots against each other we can see how different Trusts approach the waiting times targets:

Admitted vs still-waiting

If a Trust is managing its waiting lists properly, you would expect to find it somewhere near the diagonal: the waiting times of patients being admitted should reflect the waiting times of those still waiting. Trusts who are above the diagonal are likely to be those tackling their backlogs; they admitted lots of long-waiters in April and waiting times for those remaining have come down.

However we can see that a number of Trusts are below the 18 week line (so they are meeting the headline admitted-patient target) despite having lots of long-waiters still on the list. The most extreme example, where 10 per cent of those still waiting are over 42.6 weeks is University College London Hospitals NHS Foundation Trust. Here is the detail, and it illustrates nicely how Trusts can achieve the headline target and have long waiting times. (You can get more reports like this for any Trust and surgical specialty here.)

UCLH waiting time analysis April 2011

The trend for the proportion of Trusts, where at least 90% of patients still waiting are below 18 weeks, is shown next. There was a slight deterioration in April, but nothing that looks like a trend for now.

Trusts with 90% within 18 weeks – incomplete pathways

Finally, let’s look at the Trusts with the biggest changes in their underlying waiting time pressures. The spectrum of change in the previous quarter looks like this:

Change in last 3 months

Far more Trusts got better than worse, which is good news. The Trust with the biggest deterioration is Surrey and Sussex Healthcare NHS Trust, where 90th centile incomplete pathways waits have shot up since February. The Trust with the biggest improvement is South Warwickshire NHS Foundation Trust, which had longstanding waiting time pressure that has come down rapidly since December as commissioner restrictions started to bite. You can find the time trends for both Trusts here.