Chris Hopson: NHS waiting times—the long and the short of it

chris_hopsonHealth secretary Jeremy Hunt’s speech earlier this week, which called on NHS hospitals to clear their backlog of patients waiting more than a year for treatment, rightly pointed to the personal consequences of each individual case on the waiting list. While recognising that some delays are the result of patient choice or good clinical reasons, waiting for treatment if you are immobile, in discomfort, or in pain can be distressing and debilitating—the more so the longer the wait.

That’s why the Foundation Trust Network (FTN) and its members strongly welcomed the government’s pledge in June of £250m (€314m; $421m) to reduce waiting lists, and the £400m (€504m; $674m) announced at the same time to support the urgent and emergency care pathway this winter. The FTN has consistently called for extra funding to improve patient care and for any announcements to be made as far in advance as possible. We also recognise how difficult it is for health ministers to find such funding at the moment, given the need to reduce the overall budget deficit.

But we should also, at the same time, recognise that this approach has limitations.

Firstly, short term, non-recurrent injections of cash—while welcome—are never the most efficient way of funding care. A significant proportion of the waiting list money will, for example, have to be spent on agency staff and premium weekend rates because it has to be used within a set, short period of time over the summer months. Better that we allocate this money as part of mainstream NHS funding, so providers can ensure the best value is achieved.

Secondly, while it is understandable that governments will want to focus on bolstering performance against targets that attract media and political attention, there’s a risk that using short term cash to reinforce crude targets distorts clinical priorities. Jeremy Hunt was right in his speech to point to the distorting effects of the waiting time target regime. The introduction of an 18 week referral to treatment target had to be followed by another target—for 90% of the waiting list to be less than 18 weeks—which mitigated the distortions of the original target. Then we had to have another target to address long term waiters. No one would dispute the need for a clear treatment standard for patients, but better that we allow providers to set clinical priorities, and hold them to account for their overall performance within that standard.

Thirdly, there’s a real danger that ministers and arm’s length bodies will insist that short term cash injections are accompanied by burdensome, dedicated extra reporting arrangements, even though the amounts involved may be tiny in comparison to the overall budget.

The FTN’s members, for example, feel strongly that being required to submit reports and full elective waiting lists every week in effect for access to the £250 million funding is a return to unnecessary and excessive micromanagement. Better that providers account for their overall performance in a single consistent format, rather than waste energy accounting for—and being micromanaged against—individual penny packets.

Dispensing odd dollops of cash at short notice also brings challenges around consistency of delivery. In the end, it is providers who have to deliver improved levels of treatment for this extra investment. But too many of our members are telling us that they are not being properly involved in how the money is being spent, that the money taking too long to distribute, or that they do not seem to be receiving any funding at all.

It’s also worth remembering that this approach prevents the transition to the long term models of care that we desperately need—for example, greater use of out of hospital care on the urgent and emergency care pathway—as short term cash injections almost always prop up existing patterns of delivery. So while we should welcome the UK government’s extra investment in the service, we also need to recognise that there are better ways of using this money to improve patient care.

Chris Hopson is chief executive of the Foundation Trust Network (FTN), the membership organisation and trade association for NHS acute, ambulance, community, and mental health providers.

Competing interests: Chris Hopson is the chief executive of the Foundation Trust Network (FTN).  The FTN is a membership organisation, which is funded through subscriptions from its members.