Elective care

In our latest indicator update we've looked at trends in the quality of elective care.

Indicator update

Published: 30/09/2019

Care that is planned in advance is known as elective care. It involves specialist clinical care or surgery, generally following a referral from a GP or community health professional.

The elective care system is under increasing pressure. Hospital outpatient visits have nearly doubled over the past decade, from 54 to 94 million. Waiting times for elective treatment are the worst they have been since 2009, as hospitals have had to prioritise the growing demand for emergency care. Patients are waiting longer for a diagnostic test, which is delaying their access to treatments. This is also affecting patients with a suspected cancer diagnosis, where faster diagnosis often leads to improved outcomes.

The NHS Long Term Plan recently announced that there will be a fundamental redesign of outpatient services, which make up a significant portion of elective care. Over the next five years, NHS England aims to avoid up to a third of face-to-face outpatient visits through:

  • better support to GPs to avoid the need for a hospital referral
  • online booking systems
  • appointments closer to home
  • digital appointments.

In March, the Clinically-Led Review of NHS Access Standards Interim Report was released. It proposed that the 18-week threshold target for elective care would be changed to an average (mean) wait measure. Field testing of the proposed new standard began in 12 hospital trusts in early August.

QualityWatch will continue to monitor the quality of elective care and the impact of these reforms in the coming months. For now, below is a summary of our elective care indicators to date, with links to more detailed content and analysis.

See also our Combined Performance Summary reports, which summarise the latest data on some of these key measures as data is released by NHS England each month.

And take a look at our recent data visualisation on outpatient appointments.

Treatment waiting times

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  • In July 2019, only 86% of patients had been waiting less than 18 weeks to start elective treatment – the lowest proportion since January 2009.
  • The total number of people waiting for elective treatment exceeded 4.5 million in July 2019 (reported waiting list plus the estimate for missing data). This is the highest ever reported since referral-to-treatment data was first collected.
  • Between July 2010 and July 2019, the median wait time for patients still waiting increased from 5.8 to 7.3 weeks.
  • In July 2019, the median waiting time was 4.1 weeks longer for admitted patients (10.2 weeks) than non-admitted patients (6.1 weeks).

Diagnostic test waiting times

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  • The proportion of patients waiting six weeks or more for a diagnostic test increased from 0.7% in July 2010 to 3.5% in July 2019.
  • The median waiting time for a diagnostic test increased from 1.8 weeks in July 2010 to 2.1 weeks in July 2019.

Cancer waiting time targets

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  • Between Q1 2010/11 and Q1 2019/20, the percentage of people with suspected cancer having their first consultant appointment within two weeks of an urgent GP referral decreased from 95% to 90%. The two-week standard has been missed for the last five quarters.
  • The proportion of patients waiting less than 31 days for a first treatment for cancer following a decision to treat decreased from 98.4% in Q1 2010/11 to 96.1% in Q1 2019/20. The 96% threshold has not yet been breached.
  • The proportion of patients waiting less than two months to start cancer treatment following an urgent GP referral has decreased significantly over time. In Q1 2010/11, 88% of patients started treatment within 62 days compared to 78% in Q1 2019/20.

Improving Access to Psychological Therapies (IAPT) programme

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  • The number of referrals to IAPT starting treatment has more than doubled, from 533,550 in 2011/12 to 1,092,291 in 2018/19. But the number of people starting treatment must still increase considerably if the 2020/21 target of 1.5 million people is to be reached.
  • The number of people successfully finishing a course of treatment increased between 2012/13 and 2016/17, but since then improvement has stalled. In Q1 2019/20, 148,775 people finished a course of IAPT treatment, which is only 3% more than it was three years ago.
  • The recovery rate has increased gradually over time, from 46% in Q1 2012/13 to 52% in Q1 2019/20. The target recovery rate of 50% was first achieved in Q4 2016/17, and has been met since then.

Cancelled operations

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  • The number of elective operations cancelled for non-clinical reasons on the day of admission or later increased from 13,233 in Q1 2010/11 to 19,969 in Q1 2019/20 – a 51% increase.
  • The number of patients not operated on within 28 days of cancellation increased from 396 in 2010/11 to 1,727 in Q1 2019/20 – a three-fold increase.

Deprivation and access to planned surgery

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  • The most deprived decile had the lowest surgery rate, with 164 hip replacements per 100,000 population in 2017/18. The highest surgery rate was found in decile eight, with 221 hip replacements per 100,000 population.
  • Between 2008/09 and 2017/18, the rates of hip replacement decreased by 4 per 100,000 population in the most deprived decile, but increased by 15 per 100,000 population in the least deprived decile.

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