|Implemented in this survey?|
In its 1997 election manifesto the current Labour Government promised that it would reduce waiting lists by 100,000 people over the course of its first administration, that was in fact met. Through The NHS Plan and the Wanless Review the Government has proposed a number of waiting time targets, for example to reduce the max. inpatient waiting time down to three months by 2008-09, and to two weeks by 2022-23.
Waiting lists and waiting times have, over a protracted period, been viewed by the general public and the media as the number one problem facing the NHS. Over the past 15 years, successive Governments have attempted to tackle this peiceived problem. For example, in previous Conservative administrations, waiting times were a focus within The Patient's Charter in the early 1990s, which guaranteed admission to treatment within two years. The Charter was extended in 1995 to guarantee a maximum waiting time of 18 months. Over time, these targets were largely achieved. Recent Labour Governments have been concerned with both waiting lists and waiting times. In its 1997 election manifesto the Government promised that it would reduce waiting lists by 100,000 people over the course of its first administration, and did in fact meet this target. More recent Goverment aspirations have been to have a maximum inpatient wait of 6 months by 2005-06 and 3 months by 2008-09. Government rhetoric suggests that these targets will be met by, for example, offering patients greater choice of provider at the point of inpatient referral, and through a new inpatient booking system, whereby patients themselves can book their place and time of treatment. However, waiting times have fallen substantially over recent years in the absence of these incentive mechanisms suggesting that it is the increase in NHS expenditures in the period since the turn of the century that has been the driving force towards these ends. The latest Government statistics on inpatient waiting times will be presented below. The fact that the Department of Health announces these figures in the form of press releases on a regular basis highlights their importance in health care policy (it is interesting to note that in Department of Health press releases, issues that are 'perceived' to be of the most importance in the media - e.g. waiting times; BSE and it's human variant; cancer treatments and outcomes - come up time and time again).
See above. The main objectives are to improve responsiveness to what the public (and the press) seem to focus upon, and to improve access for those who would otherwise face particularly long waits.
Again see above. The rhetoric seems to be focussed mainly on financial incentives, since a new DRG-type payment system will mean that the money will follow the patient to the provider of their choice (and will therefore, in theory, offer providers the incentives to reduce waiting times). Moreover, patients will, in theory, be allowed to go to providers where there is spare capacity and thus where waiting times are already low. Thus far, however, the success in reducing waiting times appears to lie less on incentives and more on increasing NHS expenditure.
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
It was a good idea to reduce wait times initially, as waits were unacceptable long. There is a danger that reducing wait times can be taken 'too far', and may have detrimental consequences in terms of the unassessed opportunity costs of the policy. The jury is still out on the benefits (or otherwise) of policies such as more provider choice (principally because these policies have yet to be introduced), but choice may not fit into the institutional structure of the NHS (however, the inpatient booking system may well be appreciated and used by many patients). It will be interesting to see whether the Government mischievously attributes reductions in wait times that have been brought about by increases in NHS expenditure to its controversial choice proposals.
As noted above, the targets to reduce waiting lists and waiting times have been a Government policy now for many years, and have spanned several administrations (I would not therefore describe policies to reduce them as a directional 'change' - it's probably better described as policy continuity, particularly since the Labour Government plan to use market-based mechanisms, which before 1997 was perceived to be the domain of the Conservatives). However, the emphasis has probably been heightened under recent Labour governments, particularly since 2000, partly due to their 'traditional' focus as the 'political party of the NHS', and partly (I suspect) due to their need to demonstrate that their large increases in NHS expenditure are, in some sense, 'paying off'. Since waiting times are quite easy for the general public to understand and for the media to convey, they have high political visibility.
|Implemented in this survey?|
The policy to reduce waiting times arose many years ago, due to the perception (which was probably a fair perception) that waiting times in the NHS were unacceptably long. The policy to massively
increase NHS investment is widely perceived to have it's origin in Tony Blair's statement at the end of the 1990s that his Government would increase NHS expenditure up to average health care spending
in the EU. The policy to introduce choice, partly as a mechanism to reduce waiting lists, probably has it's 'formal' origin in the NHS Plan (2000), and has been championed by recent Health
Care Policy Special Advisors to the Prime Minister. The choice proposals, whereby patients will be offered the choice of four or five health care providers by their GP should to be referred for
inpatient treatment, is due to be introduced at the end of 2005.
My focus in this report is waiting time reductions as a whole (a policy which has been applied nationally for many years), rather than provider choice per se. Choice has, however, been piloted in a few areas. The results are mixed. In some studies, most people tend to prefer their local provider, which is where their GP would refer them in any case. However, in London, people seem to want to take more advantage of choice, but then in a large city such as London, the choice is not a 'strong' one - i.e. patients are offered shorter waiting times at an alternative hospital, but then since London has an abundance of hospitals the alternative hospital tends not to be much further away than their local hospital, and therefore the patient is not required to make much of a 'trade-off'.
These issues have been discussed above. It may, however, also be worth noting that some academics (including me) are a little concerned that the focus on reducing waiting times has unassessed opportunity costs, as it draws resources away from other policy initiatives. Also, the success in reducing waiting times has probably been brought about by the increases in NHS resources over recent years, and therefore is not a consequence of a 'policy reform' per se. It is therefore possible that when the country is no longer in a position to increase NHS resouces to the extent that it has done in the recent past, the success in reducing waiting times, and the (overly) ambitious targets that have been intimated in this area for the future, may raise unrealistic expectations among the general public, and may ultimately damage the NHS. After all, when implemented properly, waiting lists/times serve as a perfectly reasonable rationing device, and rationing devices over one sort or another are always needed when demand outstrips supply.
|Government||very supportive||strongly opposed|
|Media||very supportive||strongly opposed|
Government in the UK implements NHS policy and it is very unusual for the legislative process to block proposed policies in this area. The intention to reduce waits is set out in Government announcements, press releases and policy documents.
This is already discussed above.
The Department of Health monitors progress on waiting lists and waiting times, and issues regular press releases on developments in this area.
Mid-term review or evaluation
The latest Government figures on inpatient waits show that 16 English residents were waiting for over 9 months for treatment at the end of June 2005, and 3 of these had been waiting for over 12 months. The number of patients waiting over 6 months was 43,200, a decrease of 31,600 over June 2004. By the end of July 2005, the numbers waiting for more than 6 months, more than 9 months and more than 12 months, were, respectively, 15, 2 and 40,700. Perhaps around 5% of patients now wait for more than 6 months for inpatient treatment, down from around 25% at the turn of the century. Thus, the Government has almost achieved its 2005-06 target of a maximum inpatient wait time of 6 months.
The Government will probably continue achieving decreases in wait times, at least whilst the increases in NHS expenditure continue. The effect of the policies of provider choice and inpatient booking systems are, as yet, unclear, and the 'hidden' (possibly detrimental) effects of continually raising expectations on the health care system as a whole are, at this point in time, unknown.
|Quality of Health Care Services||marginal||fundamental|
|Level of Equity||system less equitable||system more equitable|
|Cost Efficiency||very low||very high|