NHS waiting times force coalition U-turn on targets

Government forced to abandon opposition to NHS waiting time targets as number of patients waiting more than 18 weeks grows

The government has been forced to abandon its opposition to NHS waiting time targets and introduce a new rule to halt the growing number of patients not being treated within the promised 18 weeks.

The U-turn is a surprise because the health secretary, Andrew Lansley, had previously criticised waiting times measures introduced by Labour to speed up patient care as "arbitrary Whitehall targets".

But fresh evidence that waiting times are creeping up, despite David Cameron's pledge to keep them low, has forced Lansley to change tack and impose an extra treatment directive on the NHS. He had previously castigated targets as unnecessary, likely to distort NHS staff's clinical priorities and part of a bureaucratic "top-down" system he intended to overhaul.

It has been prompted by the disclosure that, among the 2.6m patients waiting for treatment at any time, almost 250,000 (9.4%) do not get treated within the 18 weeks guaranteed in the NHS constitution. Among these, about 20,000 patients have been left untreated for at least a year.

On Thursday Lansley warned the NHS in England that, as of next year, no more than 8% of all patients waiting at any one time would be allowed to have had their treatment delayed by 18 weeks or more.

The service's progress towards meeting this target will be "actively monitored" as part of Lansley's belated embrace of tactics Labour used to cut the long waiting lists it had to deal with.

Lansley's decision came after he had insisted for months, despite emerging evidence to the contrary, that NHS waiting times – including treatment within four hours of arrival in A&E and access to diagnostic tests within six weeks – remained "low and stable".

Department of Health data shows the number of people having to wait for more than 18 weeks has been steadily increasing since the coalition came to power in May 2010.

Labour were quick to seize on Lansley's new approach, saying it was "an admission of failure" and proof that the health secretary had refused to heed warnings that relaxing waiting-time targets would inevitably mean unnecessary pain, discomfort and frustration for patients.

NHS waiting lists were "spiralling upwards, with a 48% increase in patients who waited longer than 18 weeks", Andy Burnham, the shadow health secretary, said.

"One of his first acts in office was to relax Labour's waiting-time standards," he said. "We warned him that patients would pay the price, and this is exactly what has happened.

"It's because of Andrew Lansley's failure to get a grip on waiting times that he's being forced to bring out these new rules. He would do better instead to focus on bringing waiting times back down to the historic low that he inherited from Labour."

The deteriorating situation would worsen if ministers pressed ahead with another controversial Lansley policy – that of abolishing the cap on the amount of income semi-independent foundation trust hospitals can make by treating private patients. Critics fear it will lead to the well-off being prioritised and ordinary NHS users having to wait even longer because staff and operating theatres are being used to treat fee-paying patients.

"Sadly, things will get even worse if he succeeds in abolishing Labour's cap on the amount of private work hospitals can do. This [abolishing the cap] will take us straight back to the bad old days of the Tory NHS, where patients are forced to choose between waiting longer or paying to go private," Burnham said.

The official data showed that 17,873 more people a month are waiting longer than in May 2010.

When comparing September 2011 with September 2010, 9,967 people had waited longer than the supposed maximum waiting time the government had guaranteed. Those comparisons include inpatients and outpatients and all those treated at the NHS's expense, either in an NHS hospital or by a private healthcare provider.

A total of 20,662 (7.1%) of inpatients treated in May 2010 had waited more than 18 weeks, but that figure rose to 23,542 (7.5%) in September 2010 and was up again to 28,926 (9.3%) by September 2011 – a jump of 40% over the coalition's first 16 months in office.

Similarly, in May 2010 a total of 15,557 outpatients (1.8%) had to wait beyond the 18 weeks, rising to 20,583 (2.2%) in September 2010 and again to 25,116 (2.8%) by September this year – a rise of 65% over the same period.

In total, 54,092 people receiving treatment in September paid for by the NHS, in an NHS or private hospital, had to wait more than 18 weeks for their procedure.

The worst affected types of treatment for inpatients are trauma – this September, 16% of all such patients had waited more than 18 weeks compared with 13% in September 2010; neurosurgery (15%, up from 10% in May 2010) and ear, nose and throat procedures (11%, up from 8% in May 2010).

Health experts such as King's Fund chief economist Professor John Appleby welcomed Lansley's recognition that targets prevent patients waiting too long.

Ruth Thorlby, a senior fellow at the Nuffield Trust health thinktank, said: "Waiting times work. [But] the Conservative Party campaigned against targets when they were in opposition. But now they find themselves apparently imposing a target." Despite increased pressure on the NHS targets remained popular with the public, she added.

The NHS Partners Network, which represents both for-profit and not-for-profit non-NHS healthcare providers, urged the NHS to use the independent sector to treat patients in order help reduce the number of those facing "excessive" waits and to keep waiting-times low.

Case study

Julia Hough, a 39-year-old emergency services call handler in Dorset, was diagnosed with endometriosis in 2002. She paid £1,400 to have surgery in Slovenia last month after being told in August that the NHS would not operate to help alleviate her condition for six to nine months.

"When I saw my consultant gynaecologist in August I was in severe pain to the extent that even walking became painful and I was having to take morphine and was off sick from work. But he told me that the wait for surgery would be between six and nine months, even though it's done as day surgery and involves less than an hour in the operating theatre. I begged to be referred to another hospital with shorter waiting lists but was refused help.

"So last month I had surgery in Slovenia on an ovary that was twisted and stuck down and on endometriosis lesions. The £1,400 is money I can't afford. I've had to opt out of my public sector pension in order to pay back the cost of the surgery, which I've put on my credit card. I'm not alone. I've noticed increasing numbers of online posts from women with endometriosis complaining about waiting months for surgery.

"Due to the 18-week rule the public are blissfully unaware that if they get sick they are very likely to not be able to get access to prompt treatment. What's the point of having a constitution when you routinely flout it?

"I'm the third person I know from my circle of friends and workmates who has had to pay for surgery privately within the last year because of long waiting lists. They had back and hip surgery respectively. People like us are being left in an impossible situation: left in pain for months on end and then being punished for the inefficiency of the NHS. Most people would view this as totally unfair and morally wrong."


Denis Campbell and James Ball

The GuardianTramp

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