Perpetual waiting in the NHS

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The NHS Constitution enshrines every patient’s right to start treatment within 18 weeks of referral by a GP, so why are patients and politicians still talking about waiting times?  Surely, after the Francis report, we should move on from being concerned about the time it takes us to get into a hospital and worry more about the quality of the treatment we’ll get and whether we will ever make it back out again.

This weekend, Andy Burnham, Shadow Health Secretary, again trumpeted Labour’s claim that, in power, they had delivered to the people what they most wanted from the NHS.  They tackled waiting times, introducing a promise of ‘18 week waits’ from diagnosis to treatment.

“When we came into power people in the NHS were dying while still on waiting lists to get into hospital, and now the NHS has the lowest waiting lists and the highest public satisfaction ratings.”

Is he right to want to keep waiting times, rather than quality of care, at the top of the political agenda?  It is certainly easier to measure and easier to hold the current government to account. 

Francis threw into stark relief what many local people and staff knew about Staffordshire Hospital, that care was poor and people died.  Despite the evidence that treatment in some hospitals harms or even kills patients, our research report, ‘Quality at a glance’, shows that it is still potentially waiting times causing people most concern when they are considering choosing which hospital to go to for an operation.  The poll was done right at the height of all the Francis coverage in the media about preventable deaths and shockingly bad care, yet waiting times were significantly more important to people than the risk of being harmed.

The most important factor when choosing a hospital for an operation for an unspecified condition

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The fear of dying before treatment or having your quality of life curtailed while you languish on a waiting list is a deep-seated fear in the public psyche.  Having been continuously fuelled by media coverage for years, perhaps most famously in the run up to the 1992 election when Neil Kinnock’s party political broadcast resulted in a media frenzy, subsequently dubbed the war of Jennifer’s ear

The broadcast was a tale of two five-year olds with glue ear, one forced to wait 11 months for treatment on the NHS and the other whose mother paid for her to have private treatment.  The use of emotive drama in a party election broadcast was an innovation and echoes of that broadcast clearly linger on at the back of editor’s minds; partly because of the power of the narrative but subsequently because both parties were undone as the real identity of the little girl with glue ear was unmasked.  

The Conservatives accused Labour of lying and exploiting a little girl’s misery; Labour accused the Conservatives of leaking details to the press and invading a family’s privacy.  The campaigns of both parties came to a juddering halt, but the idea of the NHS making people wait was given new life. The broadcast and the subsequent media furore served to cement the idea of waiting times firmly in the minds of journalists for the next 20 years.  Waiting times have stayed at the heart of media coverage on the NHS because there are three very good story ingredients:

  • The individual cases of people dying or being forced to live with disability or in pain, whilst waiting for treatment
  • The frustration expressed by clinicians in not being able to effectively prioritise urgent cases
  • The size of the investment that the Department of Health was prepared to make to bring waiting times down

Reflecting media coverage, successive Department of Health surveys have shown that public concern over waiting times has persisted.  There is evidence that overall waiting times have fallen, but broad-brush statistics don’t do much for public opinion when there are stories of individual cases of mismanaged treatment prominently displayed on the NHS choices website.  For example:

“I picked Lister’s hospital in Stevenage using this site because it said that the waiting times to see a cardiologist was only 16 days so my doctor put in for a “priority case” because my condition was detraining quite fast so I was gob smacked to receive an appointment time back from Lister’s for an appointment in 9 weeks time.”

“I’m waiting for surgery to repair a fast growing aortic aneurysm due to having Marfan Syndrome.  The 18 week waiting time is a joke. I waited 8 weeks to see surgeon which wasn’t too bad.  Was told that the wait would be 3+ months.  I’ve now been waiting 32 weeks since seeing the surgeon.  So that’s 40 weeks since I was told I needed surgery and still no sign of operation soon.”

However, our report does show that people are willing to pioritise better patient outcomes over waiting times, when they are considering treatment for a specific condition like lung cancer.  So there is an opportunity to shift this debate.

The most important factor when choosing a hospital for lung cancer treatment

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What is clear is that if politicians deprioritise emphasis on waiting times, without giving patients meaningful information about treatment outcome, those at Westminster will continue to suffer at the hands of the media.

If the Department of Health and the NHS Commissioning Board want to move beyond a media debate on waiting times, and support individuals who have been diagnosed to make an informed choice about where they go for treatment, they need to ask the newly appointed national clinical directors for different conditions to make recommendations on what they would like to see in their condition-specific aggregate quality ratings at the earliest possible opportunity.