In March 2010, the NHS Constitution was updated to include a new right for patients to start consultant-led treatment for non-urgent conditions 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 time of less than 18 weeks. In 2013/14, NHS England set an operational standard to ensure that no-one waits more than 52 weeks for treatment.
In light of the coronavirus (Covid-19) outbreak, elective activity has been put on hold to free up capacity across the NHS. This will likely have a major impact on the waiting list for elective treatment, and a catch-up programme may be implemented in the aftermath.
A review of NHS access standards began in 2019. The Interim report proposed an average wait target for people on the waiting list as a potential alternative to the current 18-week threshold target. Twelve hospital trusts began testing the use of an average (mean) wait measure in early August 2019, however due to the coronavirus (Covid-19) outbreak, publication of the review’s recommendations has been delayed. Performance of the field test sites continues to be included in the national time series, so the most recent referral-to-treatment data is unaffected by the field testing.
For further information, read the latest Nuffield Trust blog on what the proposed changes to treatment waiting time targets could mean for hospitals and patients.
The proportion of patients starting consultant-led non-emergency treatment within 18 weeks of a GP referral was consistently high following the introduction of the various referral-to-treatment 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 patients still waiting for treatment (the waiting list), the target was set at 92%. In June 2015, the admitted and non-admitted targets were abolished and the target for patients still waiting became the sole measure of treatment waiting time performance.
The 92% target for patients still waiting was breached for the first time in December 2015. Since then performance has worsened, and as of February 2020 only 83% of patients had been waiting less than 18 weeks to start elective treatment. In light of the coronavirus (Covid-19) outbreak, non-urgent elective care has been postponed. QualityWatch will continue to monitor performance on treatment waiting times throughout the outbreak, as far as possible.
As the proportion of people still waiting for treatment is currently the only 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 2.3 million by the winter of 2009. After this, there have been clear seasonal trends with the list growing over the summer and shrinking in the winter. Beyond these seasonal changes, there has been a large increase in the number of people on the waiting list for elective treatment. As of February 2020, there were over 4.4 million people on the reported waiting list, and together with the estimate for missing data the total number of people waiting for treatment exceeded 4.5 million.
The median referral-to-treatment waiting times fluctuate from month to month, but overall there has been an increase in median waits for all pathways. Between February 2011 and February 2020, waits for patients still waiting increased by 2 weeks, waits for admitted patients increased by 1.8 weeks and waits for non-admitted patients increased by 2.9 weeks. In February 2020, the median waiting time was 4.9 weeks longer for admitted patients than non-admitted patients.
The number of patients still waiting for elective treatment over 52 weeks after referral fell dramatically with the introduction of the referral-to-treatment targets. There was a peak in the summer of 2011 to around 20,000 patients, which corresponds to the relaxation of the central performance management of the targets in June 2010. After this, the number of people waiting over 52 weeks for treatment dropped to a low of 214 patients in November 2013.
Between 2013 and 2018, there was a gradual increase in the number of patients waiting over 52 weeks, with a peak of 3,516 patients in June 2018. Since then, the number decreased to 1,032 patients in the summer of 2019, but has since increased again to 1,613 patients in February 2020.
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 waiting time. There are three different treatment pathways that are measured each month:
- Admitted referral-to-treatment pathways are waiting times for patients whose treatment started during the month and involved admission to hospital.
- Non-admitted referral-to-treatment pathways are waiting times for patients whose wait ended during the month for reasons other than an inpatient or day case admission to hospital for treatment.
- Incomplete referral-to-treatment pathways are waiting times for patients still waiting to start treatment at the end of the month.
Since October 2015, no adjustments have been made to admitted referral-to-treatment pathways for clock pauses, where a patient declined reasonable offers of admission and chose to wait longer.
For further guidance on referral-to-treatment waiting times, please see the NHS England website.