|Progress towards reducing waiting times|
|Implemented in this survey?|
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.
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.
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 expenditures.
Patients, health care providers, general public, in that their perceptions of the NHS are influenced by media reports on waiting times/lists
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
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.
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.
|Implemented in this survey?|
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.
These issues have been discussed above and in 6(2005).
|Government||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 (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.
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 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.
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.
|Quality of Health Care Services||marginal||fundamental|
|Level of Equity||system less equitable||system more equitable|
|Cost Efficiency||very low||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.
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.
|Progress towards reducing waiting times|
Process Stages: Evaluation