In March 2010, the NHS Constitution was updated to include a new right for patients to start consultant-led treatment within a maximum of 18 weeks of a GP referral. In 2012, it became a statutory requirement that at least 92% of patients should have a referral to treatment (RTT) time of less than 18 weeks, and since June 2015 this has been the sole measure of treatment waiting time performance. In 2013/14, NHS England set an operational standard to ensure that no-one waits more than 52 weeks for treatment.
The Government's mandate to NHS England for 2018-19 did not include an objective for the 18-week RTT target to be met during the year, but it was included as an "overall 2020 goal".
The proportion of people starting consultant-led treatment within 18 weeks of a GP referral was consistently high following the introduction of the various referral to treatment (RTT) waiting time targets. The targets were that 90% of admitted patients and 95% of non-admitted patients should start treatment within 18 weeks of referral. For 'incomplete pathways', where patients have been referred but treatment has not yet started, the target was set at 92%. In June 2015 the admitted and non-admitted targets were abolished and the incomplete target became the sole measure of treatment waiting time performance.
The 92% target for incomplete pathways was breached for the first time in December 2015. Since then performance has worsened, and as of June 2018 only 87.8% of people waited less than 18 weeks to start consultant-led treatment.
As the proportion of people still waiting for treatment (incomplete pathway) has become the sole measure of treatment waiting time performance, it is important to look at trends in the number of people who are on the waiting list. In mid-2007, the treatment waiting list contained 4.2 million people, but this was reduced drastically to fewer than 2.5 million by winter 2009. Since then, we see clear seasonal trends with the list growing over the summer and shrinking in the winter. Beyond these seasonal changes there has been an overall upwards trend in the number of people on the waiting list. As of June 2018, there were 4.1 million people on the reported waiting list, and together with the estimate of missing data the total number of people waiting for consultant-led treatment reached 4.3 million. This is the highest ever reported since RTT data was first collected in August 2007.
The number of patients still waiting to start treatment over 52 weeks after referral (incomplete pathway) reached 20,855 in August 2010, but fell dramatically between September 2011 and December 2012. Since then, the number of patients has remained comparatively low, falling to a low of 214 patients in November 2013. However, over the past three years the number of people waiting over 52 weeks to start treatment has gradually increased again, reaching 3,517 patients in June 2018.
The median referral to treatment (RTT) waiting times for all pathways show small fluctuations from month to month. There were increases in median RTT waiting times for all pathways between June 2013 and June 2018; waits for incomplete pathways increased by 1.4 weeks, waits for admitted pathways increased by 1.1 weeks and waits for non-admitted pathways increased by 0.7 weeks over the same time period.
About this data
Once there has been a decision from a consultant that a patient needs treatment and they have been referred to a hospital, they are on the waiting list and the clock starts on their referral to treatment (RTT) waiting time. Their treatment pathway, or time on the waiting list, can end in one of two ways:
- 'Admitted': if a patient is admitted to hospital for treatment, the pathway clock stops once they are admitted either as a day case or inpatient.
- 'Non-admitted': if a patient receives treatment that does not require an admission or is not treated, the clock stops when they receive treatment or when a decision is made that no treatment is needed.
Data for 'incomplete pathways' show patients who have been referred but have not yet started their treatment. These data give an indication of the number of people on the waiting list for treatment each month.
Since October 2015, there has been no provision to report pauses or suspensions in RTT waiting time clocks in monthly RTT returns to NHS England under any circumstances.
For further guidance on RTT waiting times, please see the NHS England website.