NHS waiting times: Missed targets, missed pledges?

The NHS has been a dominant election theme once more, yet one key driver of public satisfaction with the health service has been noticeably absent from the political agenda. John Appleby and Leonora Merry look at why waiting times might be slipping under the radar ahead of election day.

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Published: 06/12/2019

As polling day draws closer, few would disagree that the NHS has played a considerable role in the noisy and, at times, fractious election campaign. There have been angry exchanges over whether or not the NHS is at risk with a trade deal with the United States (spoiler: it could be, but not in the way you might think); whether 40 new hospitals might be more accurately described as six; or how we are going to find 50,000 new nurses when that has not been achieved over five years before.

Yet one topic has been noticeably absent from the political agenda. Why is nobody talking about NHS waiting times?

A prime public concern

We have every right to be surprised by this. We know that the NHS continues to be near the top of the public’s main electoral concerns, with a recent poll by Ipsos MORI putting it higher even than Brexit. It’s also consistently been the first or second top public concern in the monthly Ipsos MORI Issues Index for the last decade.

While worries about privatisation or the possible fate of the NHS in trade negotiations may play into some of the current concerns, we also know from British Social Attitudes polling that a key driver of dissatisfaction with the NHS are worries about long waits for hospital and GP services.

The public are right to be concerned. Waiting times targets across all four UK countries are now being missed almost comprehensively. No country, for example, is currently meeting the universal maximum four-hour wait for A&E patients. Northern Ireland and Wales have not met this target for over seven years, in England it has been missed for the last four years, and in Scotland for around two years.

How far off the A&E target are the different UK countries? 06/12/2019

Chart

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Headline targets for time from referral by a GP to treatment in hospital, urgent cancer care and diagnostic tests have also deteriorated over the last few years.

How are the different targets being missed in England? 06/12/2019

Chart

Note:  


The 62-day cancer target stipulates that no more than 15% of patients should wait more than 62 days (two months) from an urgent GP referral to start a first treatment for cancer.

The A&E waiting times operational standard is that no more than 5% of patients attending A&E should have to wait longer than four hours to be admitted, transferred or discharged.

It is a statutory requirement that no more than 8% of patients should have a referral-to-treatment time in excess of 18 weeks.

The NHS Constitution requires that no more than 1% of patients should have to wait longer than 6 weeks for a diagnostic test.

Source:  

 NHS England

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Manifestly absent

Yet in spite of this obvious downward trend in hospital waiting times performance, there is a notable absence in all three main election manifestos of any concrete pledges or plans to tackle the growing backlog of patients in England waiting to be treated.

The Conservatives say that their pledge on funding (a real annual increase of around 3.3%) will in part be used “to bring down operating waiting times [and] improve A&E performance”, but lack any detail on how this will be done and by when.

Labour’s manifesto is even more elusive, not mentioning “waiting times” or “target” once in its 107 pages, making it the first Labour manifesto not to address this since Michael Foot’s infamous 1983 “longest suicide note in history”. In fairness, their accompanying Rescue Plan for the NHS states that this extra money would be used “to restore constitutional standards on waiting times and access, including ensuring 95% of patients are treated within 18 weeks [and] improve A&E performance”.

But detail on how this will be achieved is missing, which is particularly surprising given that this represents a tougher target for planned care (where the current target is 92%). 

Meanwhile, the Liberal Democrat manifesto – which promises real funding increases of around 4% per year – focuses on waiting times for mental health services, promising to “introduce further mental health maximum waiting time standards, starting with children’s services, services for people with eating disorders, and severe and enduring conditions”.

They also promise to “listen and act” on recent problems with consultants’ pensions, which has added to difficulties in tackling waiting times more generally. But they are silent when it comes to specific pledges on hospital waits.

Too weighty to tackle?

So why then, if deteriorating waiting times are such a key concern for the public, has this campaign not seen the same focus on it as in previous elections?

The answer may possibly lie in the thorny issue of the tools needed to actually drive down waiting times and meet targets. A combination of money, staff and capacity in both the public and private sectors are the ingredients needed – and used in previous years – to get waiting times back on track.

While all parties are to be applauded for grasping the nettle on money, staff shortages remain rife and look set to worsen after Brexit. And on capacity, Labour – traditionally the party who have been most vocal on waiting times – have cut off the private sector route used so effectively to reduce waits in the early 2000s, with their “urgent priority to end NHS privatisation”.

The election result will be announced next Friday as yet more statistics are published on NHS waiting times. And while predicting the makeup of the next government is anyone’s guess, one thing is certain: people can expect to wait too long for treatment well into the next decade. 

Suggested citation

Appleby J and Merry L (2019) “NHS waiting times: Missed targets, missed pledges?” Nuffield Trust comment.

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