Alan Nye on hitting the 18-week target

Richard Lehman Some doctors have been complaining of a targetitis epidemic within the NHS for years. Such world-weariness should not detract from confirmation that the health service in England has achieved its commitment to treat patients within 18 weeks of referral – where clinically appropriate and convenient to the patient.

Five years after the pledge was first made as a central plank in the NHS Plan, we can congratulate and thank clinical, managerial and support staff across primary and secondary care for the dramatic changes in working practices and service design which made this week’s announcement possible.

Of course, there are clinicians who are both wary and weary of centrally-set targets. What the 18 weeks commitment represents is an over-arching theme for the NHS throughout England – faster access to high quality care based on need. Or, to put it another way, an end to unnecessary waits.

Achieving that provides a bedrock for an NHS which can now enjoy increased freedoms to respond to local priorities and which provides patients with choice and control. If targetitis did exist, the delivery of the guarantee of relatively short waits for treatment is the antidote.

Waits are now at their shortest since NHS records began, While we may have highlighted the 18 week guarantee, median waits in January were 8.6 weeks for admitted patients and 4.6 weeks for those not requiring admission to hospital.

Our social research confirms that both the public and clinicians recognise shorter waits are central to the future success and development of the NHS.

Shorter waits mean less worry and stress for patients and their families, as well as the obvious benefit of earlier relief from pain or discomfort. New care pathways allow patients to track their progress and understand more about each stage of the journey from referral to tests, pre-assessment and final treatment.

Those pathways have been developed locally by local health communities, often leading to closer and stronger relationships between primary and secondary care organisations and professionals. They often mean more services are offered in GP practices or other community settings, improving efficiency and making the experience more convenient for the patient.

As I am writing this from Whitehall, readers are doubtless waiting for me to emphasise that the 18 Weeks commitment could not have been met without the increased resources poured into the NHS over recent years. I won’t disappoint you – this could not have been done without additional money.

But the service re-design, overhauled diagnostic procedures and the imagination and enthusiasm of health service clinicians and managers have brought about the revolution which has made the most of the new money. It is in investigations that particularly spectacular progress has been made, notably with MRI and audiology.

The professional organisations have often provided a sterling lead in this. For example, the Royal College of General Practitioners has emphasised to members that the best outcomes are achieved by the patient, GP and specialist all working together to determine the pathway of care.

The Royal College of General Practitioners has reminded members that they can work with secondary care colleagues to improve communication and information sharing – while also improving the booking of hospital appointments and the synchronisation of tests .

Writing this for the BMJ website, I would be naïve to claim that last week’s announcement is confirmation that no part of the English NHS is struggling with waiting times. Similarly, clinicians and other staff might feel that striving to deliver this ultimate target has increased their workload.

To those feeling a touch of cynicism or scepticism, I would conclude with one pledge and one thought based around the social research referred to above. Just as achieving the target in January represents the start – not the end – of this process for local health communities, so it does for the Department of Health and strategic health authorities.

We will continue to provide all the support we can to ensure the performance is sustained. Our website, will continue to provide extensive information and best practice updates on waiting times.

We will also continue to run events: our national coaching programme for orthopaedics – a specialty which has made spectacular progress in reducing waiting times but which is still narrowly short of the target – will continue through 2009.

Evidence suggests that local health communities which have participated in the coaching programme have made more progress than those that have not.

We are also publishing a sustainability toolkit intended to help local health communities maintain the impressive progress they have made.

The social research quoted above suggested that three-quarters of clinicians supported the maximum waiting time; those with positive views cited reasons such as improved clinical outcomes, better synchronisation of treatment and reduced stress for patients.

Patients who receive quality treatment more quickly, and who know what is happening at each stage of their journey along the pathway, are likely to be happier and more relaxed.

In the end, that is surely a state of affairs which will boost your job satisfaction.

Alan Nye is a GP in Oldham, Lancs, and a member of the Department of Health’s 18 Weeks Clinical Advisory Group.