The English referral-to-treatment (RTT) waiting list grew by a total of 60,000 patient pathways in May.
Analysis produced for Health Service Journal by Dr Rob Findlay, Director of Strategic Solutions at Insource Ltd and founder of Gooroo Ltd
That month is typically associated with seasonal waiting list growth of about 55,000 pathways, so this represented long-term growth of about 5,000 pathways, taking the NHS even further from its goal of restoring ’18 weeks’.
The latest trajectory towards a successful ’18 weeks’ restoration by the deadline of March 2029 – which was a prominent government manifesto pledge – required the list to shrink by 29,000 pathways in May, so this was a ‘miss’ of some 89,000 pathways against that trajectory.
That ‘miss’ will now be carried forward for delivery in future months, and the next updated trajectory will be correspondingly steeper.
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
According to the latest trajectory for a timely restoration of ’18 weeks’, the RTT waiting list needs to shrink by between 29,000 and 137,000 patient pathways per month, depending on seasonality. The month of May typically sees the largest seasonal waiting list growth, and therefore the seasonally-adjusted trajectory for May is at the low end of the waiting list reductions required. However in real life the waiting list did not shrink at all, and instead it grew by some 60,000 pathways.
The chart below highlights how the waiting list has changed from one year to the next. It fell slightly year-on-year, by 78,000 pathways. But that is far too slow: the latest recovery trajectory calls for much larger reductions of 999,000 per year.
Most of the waiting list is at the outpatients and diagnostics stage of the RTT pathway: some 6.0 million out of a total 7.3 million patient pathways. There is a sensible drive to tackle outpatient waits at the moment, but instead the number waiting for outpatients and diagnostics went up.
After the outpatients and diagnostics stages, a minority of patients receive a Decision to Admit for treatment as an inpatient or daycase. The waiting list for these pathways increased and is now significantly larger than last year. This is also the expensive end of the waiting list, because these patients will need highly-staffed theatres and wards so the cost of reversing this waiting list growth will be significant. And if that recovery is left too late, hospitals may find that they do not have enough physical capacity to treat them before the March 2029 deadline.
A rising waiting list means rising waiting times, right? Not necessarily. Waiting times are a function of both the size and shape of the waiting list, so it is possible for the waiting list to grow and waiting times to fall, which is exactly what happened in May when waiting times fell slightly to 38.6 weeks RTT. Waiting times from referral to diagnosis and decision similarly fell to 36.3 weeks, which is far too long if you are one of the estimated 25,817 patients on the RTT waiting list whose eventual diagnosis will unexpectedly be cancer.
The other factor in waiting times – the shape of the waiting list – is summarised in the index below. It improved slightly in line with seasonality. It remains poor, although it should improve naturally as waiting times fall towards 18 weeks.
Looking at specialty-level waiting times, ENT and Urology held onto their improvements from recent months while many other specialties saw their waits edge up.
There is occasional speculation in the media that waiting lists are coming down because patients are being removed from the waiting list in an error-correction process known as ‘validation’, rather than being diagnosed, treated and discharged. This was a factor in March, but according to the back-calculated estimates below it was not a factor in May.
Referral-to-treatment data up to the end of June is due out at 9:30am on Thursday 13th August.
