The English referral-to-treatment (RTT) waiting list grew by 112,000 patient pathways in April, reversing the gains of March’s ‘sprint’ and returning the list size to a little larger than it was at the end of February.
Analysis produced for Health Service Journal by Dr Rob Findlay, Director of Strategic Solutions at Insource Ltd and founder of Gooroo Ltd
It is normal for the waiting list to grow seasonally at this time of year, and when that is taken into account the figures are not quite as bad, with March and April producing a modest long term wait list improvement of around 80,000 pathways.
But those long term improvements are not fast enough to restore 18 week waits by 2029 as the government has pledged. The waiting list should have shrunk by 33,000 pathways in April to stay on its recovery trajectory, instead of growing by 112,000.
In the following discussion, all figures come from NHS England. You can look up your trust and its prospects for achieving the waiting time targets here.
The numbers
The waiting list needs to shrink to around 4 million patient pathways by March 2029 to restore the statutory standard that 92 per cent of the waiting list should be within 18 weeks of referral, a figure which is in line with NHS England’s estimate.
So far the waiting list has come down a bit, but the rate of improvement has been far too slow. Every shortfall against trajectory is carried forward into future months, and the trajectories keep getting steeper – in the chart below, the latest trajectory is some 20,000 pathways per month steeper than the first. The shortfall in April was comfortably the largest so far, and that too will need to be made up in future months.
The March year-end sprint benefited from a surge in unreported removals, as trusts checked their waiting lists and removed patients who were recorded there in error. This surge was also largely reversed in April, which could indicate that trusts were running out of errors to find.
The charts above include adjustments for non-reporting trusts, and this mattered in April because another trust dropped out of the data series. The charts below have not been adjusted, so the rise in the waiting list size in April was actually a bit worse than shown in the next chart.
Waiting times rose after a few months of worthwhile improvement, and this is what matters to patients. For those patients who have not yet reached diagnosis and decision, waiting times increased in April by 0.2 weeks to 36.4 weeks, which is far too long for the estimated 25,596 patients whose eventual diagnosis will unexpectedly be cancer.
Waiting times are a function of both the size and shape of the waiting list, and the next chart is a measure of the shape. This is expected to improve naturally as the size of the waiting list comes down, and it had better, otherwise the waiting list would need to shrink to even smaller than 4 million to restore the ’18 weeks’ standard. However there is little sign of improvement so far.
The general increase in waiting times was seen in most specialties, with a few worthy exceptions including Ophthalmology and Paediatrics. ENT deserves a mention for holding its position in April, having brought waiting times down sharply in recent months.
Referral-to-treatment data up to the end of May is due out at 9:30am on Thursday 9th July.
