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Further progress towards reducing waiting times

Country: 
United Kingdom
Partner Institute: 
London School of Economics and Political Science
Survey no: 
(7)2006
Author(s): 
Oliver, Adam
Health Policy Issues: 
Access, Responsiveness
Reform formerly reported in: 
Progress towards reducing waiting times
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no no no yes no
Featured in half-yearly report: Health Policy Developments 7/8

Abstract

Efforts to reduce waiting times and waiting lists are a major - possibly the major - aspect of Government health policy. This report is the latest in an ongoing series of reports that detail the progress that has been made towards reducing inpatient waiting times, and will cover the period from October 2005 to February 2006.

Purpose of health policy or idea

As detailed in a previous report [6(2005)], Goverment aspirations have been to have a maximum inpatient wait of 6 months by 2005-06 and 3 months by 2008-09 (however, the Government has just announced a new target of a maximum 18 week wait from referral by a general practitioner (GP) to treatment - this latest target should be taken as the new official target).

Government rhetoric suggests that these targets will be met by, for example, offering patients greater choice of provider at the point of inpatient referral (from January 2006, patients have been offered a choice of at least four hospitals when referred for treatment by their general practitioner), and through a new inpatient booking system, whereby patients themselves can book their place and time of treatment. Moreover, on March 17th 2006, the Government announced that from April 2006, patients who have faced a long wait for diagnostic scans (i.e. over 20 weeks) - e.g. MRI, CT and ultrasound scans - will be offered the choice of going to a different hospital than the one originally intended so that they can have their scan done more quickly. It is hoped that this policy will also speed up the entire treatment process.

The latest Government statistics on inpatient waiting times will be presented below, although it should be borne in mind that any success that the Government has thus far had in reducing waits is not a consequence of their patient choice policies, which have only just been introduced; rather, it is most likely a consequence of the substantial and sustained increases in NHS expenditures since 2000.

Main points

Main objectives

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.

Type of incentives

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 expenditures.

Groups affected

Patients, health care providers, general public, in that their perceptions of the NHS are influenced by media reports on waiting times/lists

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Characteristics of this policy

Degree of Innovation traditional traditional innovative
Degree of Controversy consensual consensual highly controversial
Structural or Systemic Impact marginal neutral fundamental
Public Visibility very low very high very high
Transferability strongly system-dependent system-dependent system-neutral

As noted in the previous report on waiting times, it was a good idea to reduce wait times initially, as waits were unacceptably long. But 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.  

Political and economic background

Although there has been a long history of attempts to reduce waits, the emphasis has been heightened under recent Labour governments, particularly since 2000. Waiting times/lists are quite easy for the general public to understand and for the media to convey, and have high political visibility. Therefore, the Government is keen to reduce the waits, not only due to what I think is a genuine belief of senior Government officials that this would improve the NHS, but also because it gives the Government good ammunition to demonstrate that their large increases in NHS expenditures are reaping rewards (and therefore potentially serve as a good electoral asset; on the flip side, if they do not reduce waits, their health care policies would come under serious attack). Given their rhetoric over the last several years, reducing waits is now crucial to the current Government.

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no no no no no yes no

Origins of health policy idea

Again, as detailed in 6(2005), the policy to reduce waiting times arose many years ago, due to the perception that waiting times in the NHS were unacceptably long (at more than two years for some procedures in the 1980s). 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 main choice proposal (thus far), where patients are offered the choice of at least four health care providers by their GP at the time of inpatient referral, was eventually introduced in January 2006.

Initiators of idea/main actors

  • Government: The Government has a very powerful influence over all NHS health policy in England and Wales, and thus, by definition, it will be very supportive of any policy that it implements. The general public and the media are important influencers on the particular issue of waiting times policies, because the media has for many years used these figures as an indicator of whether or not the NHS is ?succeeding? or ?failing?, and waiting lists/times are a very simple metric for the general public to understand. Thus, reduced waits have been equated with an improvement in system responsiveness, and the Government makes a big deal out of these ?improvements?. However, although the media and the general public are supportive of waiting time/list reductions, I do not have the impression that these ?groups?, or the health care research and policy community in general (with a few prominent exceptions), are particularly supportive of the patient choice policies.

Stakeholder positions

These issues have been discussed above and in 6(2005).

Actors and positions

Description of actors and their positions
Government
Governmentvery supportivevery supportive strongly opposed

Influences in policy making and legislation

Government in the UK implements NHS policy and it is very unusual for the legislative process to block proposed policies in this area (although following the reduction in the Government's majority in the House of Parliament after the June 2006 General Election, legislation is probably blocked more often than it was previously). The intention to reduce waits is set out in Government announcements, press releases and policy documents.

Legislative outcome

success

Actors and influence

Description of actors and their influence

Government
Governmentvery strongvery strong none
Government

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Adoption and implementation

This is already discussed above.

Monitoring and evaluation

The Department of Health monitors progress on waiting lists and waiting times, and issues regular press releases on developments in this area.

Review mechanisms

Mid-term review or evaluation

Dimensions of evaluation

Process

Results of evaluation

The latest Government figures on inpatient waits show that 48 English residents were waiting for over 6 months for treatment at the end of December 2005, of which 13 had been waiting for over 9 months and 2 for over 12 months. The total number of patients on the waiting list at the end of December 2005 was 784,300, a fall of 73,900 over December 2004. By the end of January 2006, the numbers waiting for more than 6 months, more than 9 months and more than 12 months, were, respectively, 74, 22 and 5, and the total number waiting was 791,800, a small increase over the Christmas period, but a decline of 70,100 over January 2005. By the end of February 2006, the numbers waiting for more than 6 months, more than 9 months and more than 12 months, were, respectively, 116, 17 and 0, and the total number waiting was 789,800,a fall of 55,500 over February 2005.

Expected outcome

The Government, through a mix of targets and money, have managed to maintain their progress towards lowering waiting times/lists and their targets in this area seem to be more or less secure. However, 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, but are likely to place further financial strain on the NHS.

Impact of this policy

Quality of Health Care Services marginal rather fundamental fundamental
Level of Equity system less equitable neutral system more equitable
Cost Efficiency very low neutral very high

The overall policy to reduce wait times has clearly had an impact and if there was now a noticeable increase in waiting times, the Government's health service reforms would either come under severe strain, or would be implemented far more aggressively than they already have been. I would think that probably the former would happen, because the Government's majority in the House of Commons is now insufficiently large for them to trample over the views and preferences of 'grassroots' Labour party members.  

References

Sources of Information

Department of Health. Statistical Press Notices: NHS Waiting List Figures. Department of Health:

Department of Health. More action to tackle hidden waiting lists. Department of Health: London, March 17 2006.

Department of Health. Waiting lists continue to fell despite winter pressures. Department of Health: London, March 31 2006.

Reform formerly reported in

Progress towards reducing waiting times
Process Stages: Evaluation

Author/s and/or contributors to this survey

Oliver, Adam

Suggested citation for this online article

Oliver, Adam. "Further progress towards reducing waiting times". Health Policy Monitor, April 2006. Available at http://www.hpm.org/survey/uk/a7/1