In addition, he concluded that there was a backlog of a further 600,000 patients who would also need to be treated to recover the standard overall. How is COVID-19 changing the use of emergency care? April 2020 saw just over half the number of emergency admissions than the same month in 2019; returning to normal could see emergency patients potentially reoccupying tens of thousands of hospital beds. It is estimated that up to 14 million dental appointments could have been missed across the UK over the course of the pandemic. Our estimates depend on the NHS’ ability to efficiently deal with waiting lists. Waiting Times Referral To Treatment (RTT) The current wait times for treatment are available by clicking the link below. At the end of April 2020, the NHS in England was asked to begin a cautious programme to begin resuming the routine services suspended in response to COVID-19. All specialties but one (geriatric medicine) have missed the target since November 2018. ‘The NHS went into Covid-19 with a workforce crisis and rising waits for care. 'The impact of Covid-19 on waiting times for NHS patients will be felt for years to come': The King's Fund responds to latest NHS performance statistics, Performance against key national waiting time standards has deteriorated in recent years, leaving many people waiting longer for. But until the health service has the capacity it needs to meet demand – and the support of a sustainable system of social care – a promise to recover 18-weeks within this parliament would be putting the cart before the horse. Until the health service has the capacity it needs to meet demand...a promise to recover 18-weeks within this parliament would be putting the cart before the horse. ‘The NHS went into Covid-19 with a workforce crisis and rising waits for care. This. The 'Start now' button below will open the NHS e-Referral Service booking website: Manage Your Referral. The rates of spending growth, set out in the NHS Funding Bill in February 2020, will not be sufficient to cover the cost of meeting the 18-week standard by March 2024, even before any additional costs and demand arising from COVID-19. In January 2020, before coronavirus (COVID-19) began to impact on the UK, more than one in six patients were waiting  more than 18 weeks for routine treatment. Table 1: Estimated cost of returning to the 18-week standard. We estimate the total direct cost of treating 92% of patients within 18 weeks to be £5.2bn–6.8bn, including elimination of the backlog by the end of March 2024. This demanded a different mindset to the previous ‘stage of treatment’ targets. But this transformation has not been sustained and waiting times are now making the headlines for all the wrong reasons. The 2000s were the era of ‘targets and terror’, but delivery took more than performance management. In January 2020, before large numbers of COVID-19 hospitalisations, a total of 4.4 million patients were on the waiting list – around 730,000 of whom had waited more than 18 weeks. If the backlog of patients waiting more than 18 weeks was evenly distributed across the 4 years (from the start of 2020/21 to the end of 2023/24), the NHS would then need to treat: Our analysis suggests that the further lengthening of waiting times since publication of the NHS Long term plan means that the rates of spending growth, set out in the NHS Funding Bill in February 2020, will not be sufficient to cover the cost of meeting the 18-week standard by March 2024. NHS patients should be treated within 18 weeks of being referred with the total NHS waiting list now at more than four million. Even with the positive news of a vaccine, the impact of Covid-19 on waiting times for NHS patients will be felt for years to come. Other hospitals have seen similar spikes in waiting times. Prior to COVID-19, planning guidance expected waiting lists to reduce in 2020/21. Over the coming years there will need to be long-term changes to how routine care is delivered, considerable effort at the front line and potentially an important role for the independent sector if the NHS is to return to a position of meeting the 18-week standard. The imperative to keep patients with COVID-19 separate will prevent the NHS from returning to pre-pandemic levels of bed occupancy, which reached 92% by the end of 2019. Our 29th QMR looks at where the NHS. 'Roughly 1 in 12 people in England are awaiting NHS treatment': The King's Fund responds to the latest NHS monthly performance data. 40,000 additional cases at an average cost of £1,800, 175,000 ((1.3m – 600,000) / 4) cases per year at an average cost of £2,800. In the winter of 2017, 8% of patients were waiting over 21 weeks for their referral; this rose to 25 weeks by the end of January 2020, with 4.42 million people on the waiting list. Since 2017 the backlog of patients has also grown. Key points • Reducing elective waiting times from ‘18 months to 18 weeks’ was one of the English NHS' major achievements in the 2000s. Nearly 1 in 12 people on NHS waiting lists have been stuck waiting over a year: The King’s Fund responds to latest NHS hospital performance stats. All financial figures are in 2019/20 terms. care; there is little prospect of recovery in the foreseeable future. briefing examines the data on hospital beds, explores the drivers underpinning the changes observed and considers whether STPs’ proposed bed reductions are realistic. December 2008, but diagnostic waiting times now form part of the NHS Constitution. Long waits may mean patients experience additional pain, anxiety and inconvenience, and may lead to higher risk of harm and poorer outcomes. Our estimates are the direct costs of treating these additional patients. At the end of April, the NHS in England was asked to begin a cautious programme to resume some of the routine services. Meeting the 18-week standard would require hospitals to increase the number of patients they admit by an amount equivalent to 12% of all the patients admitted for planned care in 2017/18. What is more interesting is the likely impact of the covid-19 shutdown on the very longest RTT waiting times. But this figure was at 4,100 last year. This was all in the context of substantial growth in funding and staff numbers. The NHS has a “hidden waiting list” of 15.3 million patients who need follow-up appointments for health problems, according to … This can be quantified through the index of waiting list management, a measure of how effectively hospitals are allocating their resources and how quickly the NHS can treat a given list of patients. This is before the impact of COVID-19 on both demand and capacity is taken into account. But even with huge efforts, the reality is that longer waiting times for planned care are likely to be a feature of the NHS in England for several years at least. Today the number of patients in hospital with COVID-19 is falling, but many of those discharged will need aftercare and ongoing support for example from mental health, primary and community health services. You can also read about the COVID-19 vaccine and what will happen on … Fundamentally, NHS activity to complete pathways and remove patients from waiting lists has not kept pace with the growth in demand. We look for talented and passionate individuals as everyone at the Health Foundation has an important role to play. Part of the additional £20.8bn real-terms funding increase between 2018/19 and 2023/24 is earmarked for reducing waiting times. Various measures in the NHS Long Term Plan should support more efficient delivery of some of the additional activity needed, but are unlikely to substantially reduce demand. Hospitals are putting on extra surgery sessions in the evenings and at weekends to tackle the NHS’s spiralling waiting list and cut waiting times for patients. However, demand for the service has increased significantly over recent years and, although the number of referrals is now gradually coming down, this has led to long waiting times. RT @BecksFisher: General practice in areas of high deprivation is under-funded and under-doctored relative to need. Figure 1 shows the percentage of patients on the waiting list for over 18 weeks by region in January 2020 – this is compared to the 8% (100%–92%) target. This would require hospitals to increase the number of patients they admit by an amount equivalent to 12% of all the patients admitted for planned care in 2017/18. This would be an unprecedented increase in activity. This gives patients the legal right to treatment within 18 weeks of referral (18 week RTT) and as part of this, pledges that patients should not be required to wait six If you've had a positive COVID-19 test, you should wait 4 weeks from the date you had the test before you book an appointment. In 2017, waiting times specialist Rob Findlay published estimates of the cost of meeting the standard to start elective treatment. The covid-19 elective shutdown began in mid March. Managing the process efficiently and effectively is critical to reducing waiting times. And international comparisons showed that the UK no longer had some of the longest waits – the median wait for a hip replacement in the UK fell from 215 days in 2001 to 78 by 2008. This index improved from 2011 to meet the current standard, but has deteriorated since the beginning of 2016. Can the NHS afford to meet the 18-week standard? Patients will need reassurance about the risk of catching COVID-19 in hospital settings, while the virus must now be a factor in clinical judgements about the balance of risk for different care options. Please upgrade your browser. Admissions virtually ceased. But this did not always reflect the reality of how long people waited. Waiting times have increased in all regions and specialties. This analysis therefore presents the activity and cost implications of meeting the 18-week waiting time standard if the index returns to 2011 levels. Figure 4 is our estimate of the planned allocation of NHS funding growth. Without a radical intervention to increase capacity, it is unrealistic to expect the 18-week standard can be achieved by 2024 with current infrastructure and staffing levels. As such, they do not reflect the full scale of the challenge. The King's Fund is an independent charity working to improve health and care in England. Just 46.8% of patients were treated within 18 weeks in July, against the 92% target—the lowest since records began, data from NHS England showed. When you book you'll only be offered appointments for vaccines that are recommended for you based on your age, any underlying health conditions, and whether you're pregnant. In January 2020, before coronavirus (COVID-19) began to impact on the UK, more than one in six patients were waiting more than 18 weeks for RTT waits should of course be 18 weeks rather than 25 weeks, so an extra week is not going to be particularly noticeable in the grand scheme of things. You'll need your: booking reference number. This note provides supplementary information and guidance to enable referrals … Reducing elective waiting times from ‘18 months to 18 weeks’ was one of the English NHS' major achievements in the 2000s. This may help to slow the deterioration in performance, but even before the pandemic recovering the 18-week standard looked very challenging. If GPs responded to lower waiting times by referring more patients, for example, an even larger increase in NHS activity would be needed to meet the standard. This is based on the assumption that just over a third of the extra patients requiring treatment each year will need to be admitted to hospital. Specifically, it looks at what would have been needed – if the NHS were operating within a ‘business as usual model’ – to return to delivering the standard of 92% of patients being treated within 18 weeks, given the waiting lists and waiting times backlog that had built up by January 2020. Returning NHS waiting times to 18 weeks for routine treatment 3 . The original standards were based on completed pathways, which created a perverse incentive to treat patients who had not yet reached 18 weeks, over those who had already waited longer, to make reported performance look better. There is more that can and should be done to address the misery of long waits, and the NHS has already made commitments to do so. expected to be at the end of 2019/20, where it actually finds itself in 2020/21, and what impact Covid-19 might have in the future. A few years later, the ‘completed pathway’ standards were dropped entirely and the ‘incomplete pathway’ standard became the NHS’s single measure of elective waiting times. Delivery of waiting times was also hardwired into system reforms to enable patient choice and competition. Findlay recently pointed out that ‘4 years of waiting list growth would need to be undone to achieve the NHS Constitution standard again’. This despite it being a legal right under the NHS constitution. In January 2020, before coronavirus (COVID-19) began to impact on the UK, more than one in six patients were waiting more than 18 weeks for routine treatment. The total direct cost will depend on how efficiently the NHS deals with waiting lists. Receive the latest news and updatesfrom the Health Foundation. For further information, or to request an interview, please contact the Press and Public Affairs team on 020 7307 2585 (if calling out of hours, please ring 07584 146035). How well are waiting times being managed? Referral to treatment measurement and COVID-19 24 March 2020 Version 1 Outpatient services should be provided virtually whenever possible to progress treatment where face-to-face contact is not required. The Health Foundation estimates that spending growth would need to increase by a further £560m a year – assuming the NHS can prioritise patients to make the most effective use of available capacity. Despite the best efforts of hard-working staff, there simply isn’t the capacity to get through the backlog quickly. This section contains information on Consultant-led Referral To Treatment (RTT) waiting times, which monitor the length of time from referral through to elective treatment. Restarting planned treatment is important but will be complex. People at higher risk. This remains well below the 19.6-week median wait recorded in July 2020. 21. In total, around 7,700 patients are waiting for longer than 18 weeks between referral and treatment. What would it take to recover the 18-week standard? Admitted pathways are waiting times (time waited) for patients whose treatment started during the month and involved admission to hospital (until September 2015 adjustments were made to admitted pathways for clock pauses, where a patient had declined … NHS England Cancer Waiting Times [vi] First cancer treatments following an urgent GP referral 83% 60% Activity increases to 70% of 2018-19 average (reasonable increase after 2 successive month-on decreases of 21-30%) Activity continues to decrease to 50% of 2018-19 average NHS England Cancer Waiting Times [vi] Coronavirus (COVID-19) vaccination. Improvements in performance allowed maximum waiting times to be repeatedly revised down – to 3 months for a first outpatient appointment and 6 months for inpatient treatment in 2000 – as part of a new ‘war on waiting’. Where this is not possible, the guidance below provides advice on referral to treatment (RTT) waiting time measurement where patients are Registered charity number 286967. Unfortunately, your browser is too old to work on this website. In costing the additional activity needed to keep pace with demand, we calculate a weighted average cost of an inpatient treatment (£4,200) and an outpatient-based treatment (just over £500). The number of patients treated within 18 weeks of referral has fallen by more than half compared with the same time last year, figures show. NHS England collects and publishes monthly referral to treatment (RTT) data, which are used to monitor NHS waiting times performance against the standards set out in the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) Regulations 2012, and the 2015 amendment. Deborah Ward, Senior Analyst at The King’s Fund, comments on the monthly performance data on A&E, referral to treatment and diagnostics. With current staffing levels it will be a challenge just to keep up with demand, let alone reduce the backlog.’. In 2004 this crystallised into the ambition to reduce waiting times from ‘18 months to 18 weeks’. There have been just under 4 million fewer referrals for hospital care since March this year compared to the same time last year, with more patients having their conditions managed by their GP or in the community. Waiting times are routinely identified as an important factor in public satisfaction with the health service and patient experiences of NHS care. Financial penalties for not meeting the 18-week standard were introduced in 2012, which led to more effective prioritisation of cases and management of patient flow. Incomplete pathways are waiting times for patients waiting to start treatment at the end of the month. In March 2020, after the onset of the Covid-19 pandemic, non-urgent elective activity was postponed to free up inpatient and critical care capacity. However, the additional measures that will now be needed to deliver planned care – as well as the risk of having to up- and downscale activity to manage local outbreaks of COVID-19 – will present substantial challenges to efficiently managing waiting lists. 21. For all the strengths of a taxpayer-funded NHS free at the point of use, long waits were often seen as the inevitable downside of the Beveridge model. Waiting lists are as old as the NHS, but targets for waiting times are a more recent phenomenon dating back to the Patient’s Charter introduced in 1992. For planned hospital care, this challenge has to be seen against a backdrop of growing waiting lists and waiting times. WAITING lists across the NHS have reached the highest levels since records began due to the coronavirus pandemic. As the NHS looks to start to recover services, this analysis looks at the context in which planned treatment will recommence. In this high-cost scenario the backlog is estimated to be higher in March 2020 at 1.6 million instead of 1.3 million. “The total number of patients waiting six weeks or more from referral for one of the 15 key tests is at almost 571,500 — 58.5 percent of the total number of patients waiting … Head of Press and Public Affairs, Cara Phillips We now have referral-to-treatment waiting time data up to the end of March. There will need to be longer term changes in how planned care is delivered and the independent hospital sector could play an important role, after it was virtually block-booked early in the pandemic to provide additional capacity. This results in a higher cost of recovering the 18-week standard of £6.8bn. To address this, the coalition added an additional standard for 2012/13 that at least 92% of patients still waiting to start treatment should have waited 18 weeks or less. decide which measurement and feedback tools are appropriate for their requirements. It is also highly possible that the cost of the recurring additional activity is higher than the estimated average; here the recurring costs have been inflated to match the backlog clearance (£2,800). And, in January 2020, before COVID-19 began to impact on the UK, more than one in six patients were waiting for more than 18 weeks. Long waits for care are a 'timely reality check on the challenges facing NHS services': The King's Fund responds to September's monthly NHS hospital activity figures, Press centre and parliamentary activities. Before we factor in COVID-19’s impact, given the gap between current performance and the standard, what would it take for at least 92% of patients to begin treatment within 18 weeks, how much would it cost and is there a realistic prospect of delivery by 2024? Referral to treatment waiting times statistics for consultant -led elective care for April 2019 ... NHS England Published ... (COVID-19) Coronavirus … COVID-19 makes the challenge even greater. In 2013/14, NHS England set an operational standard to ensure that no-one waits more than 52 weeks for treatment. If your cancer referral is from a screening programme, 87% are now left anxiously waiting over two months for treatment. A typical pathway involves three stages: The 3 and 6 month targets could be met but, with no comparable measure of time spent in the second stage, some patients still experienced long delays. The system of Payment by results rewarded trusts for expanding elective activity, and being on track to hit 18 weeks was a prerequisite for applying for coveted foundation trust status. This figure was based on Findlay’s initial estimates of the recurring pressures and backlog of 170,000 and 600,000 patients respectively. By 2023/24 the NHS must see and treat an additional 1.3 million people over the next 4 years, to address patients already on the list and eliminate this backlog. Book or manage your COVID-19 vaccination appointments. In 2002, the Labour government committed to a major injection of NHS funding with one of the key aims being to dramatically reduce waiting times for NHS elective care in England. The government has set out funding plans for NHS England up to 2023/24, showing that spending will increase by £20.8bn in real terms by 2023/24. General and acute bed occupancy in England was already at 92.0% – the maximum set by NHS England and Improvement – at the end of 2019 and nursing vacancies were over 40,000. Staffing shortfalls, bottlenecks in diagnostic services and high levels of bed occupancy will continue to constrain hospital capacity, with scope for elective activity to be crowded out by increasing demand for emergency care. Press and Public Affairs Manager, Rachel Case Gbemi Babalola, Senior Analyst at The King’s Fund, comments on the latest NHS hospital activity figures. Around a third of people on the waiting list will need a spell in hospital. This is more than double Findlay’s 2017 estimate of the backlog. The numbers above would require almost 2.2 million more outpatient appointments and elective admissions in 2023/24. These calculations are based on Health Foundation and IFS projection modelling, which estimates that £5bn would be needed to deliver NHS waiting times standards, including the 18-week standard, and return NHS providers to financial balance.
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