NHS gooroo blog

Archive for May, 2012

Here is the local picture on 18 week waits, fully updated with the March 2012 waiting times data just released by the Department of Health for England.

If you want to pick a Trust or PCT, and get a full analysis of the pressures in any specialty, then all the detail is here: Gooroo reports

Where are the long-waiters?

If you’re a local journalist, or just want to see where the longest-waiting patients are, here is a summary map. Click on any pin to get year-on-year data for the total list size, 18-week waiters, and over-one-year waiters.

If you want the same map broken down by specialty, here it is. In this map the pins are clustered, so you can click to zoom in on any Trust. When the Trust turns into a pin, click it, and you’ll get the detail in a balloon for one specialty. To see more specialties, look for the page number in the bottom right corner of the balloon.

For a population-level view of where the longest-waiters are, here is a summary map on a commissioner (PCT) basis:

Similarly, here is the PCT map broken down by specialty.

How hard is the 92 per cent target?

If you work in the NHS, and want to know how difficult it will be to achieve the new target (that 92 per cent of incomplete pathways must be within 18 weeks), then these interactive maps have the detail.

First by Trust:

and by PCT:

Again, in this map the pins are clustered: click to zoom in; when the pie chart turns into a pin, click it, and you’ll get the detail in a balloon for one specialty. To see more specialties, scroll through the page numbers in the bottom right corner of the balloon.

The English NHS broke new records again in March, with the number of patients on the waiting list over 18, 26, 39 and 52 weeks all hitting new record lows, and with all three 18-week targets met.

Although the pace of improvement for the very longest-waiters has slowed, the number of over-18-week waiters is down a massive 100,000 year-on-year to just 160,052.

One-year-waiters fell to 5,141 (from 5,696 the previous month, and 14,355 a year before), and remain concentrated in London where 2,106 patients are still waiting over a year after referral (and that omits Imperial who are still on a reporting holiday).

You can download our Gooroo NHS waiting times fact checker

England-wide picture

The NHS continues to show remarkable consistency in both the number of patients being admitted, and the size of the waiting list.

Records were broken for all measures of long-waiters still on the waiting list, with the number of over-18-week waiters falling by one-third since last July.

The new and much better “92% of incomplete pathways within 18 weeks” target was activated on the 1st April, and the NHS has risen to the occasion with an early, convincing and sustained achievement of the new target.

All specialties improved, although neurosurgery is still the most-pressured specialty.

The new target must be met in every NHS organisation, in every specialty, and that is going to take a little longer. March saw the highest ever proportion of Trust-specialties achieving the new target, beating by a percentage point the previous record set at the time of the last General Election.

 

Trust top twenty

The twenty Trusts with the greatest waiting times pressures (omitting Imperial who did not submit data) are:

Trust	92% of waiting list is within	Position in March	Change	Position in February	Over-one-year waiters on list
The Robert Jones & Agnes Hunt Orthopaedic Hospital NHS FT	35.8 weeks	# 1	up 1	from # 2	49
Oxleas NHS Foundation Trust	32.4 weeks	# 2	down 1	from # 1	43
Pennine Acute Hospitals NHS Trust	25.0 weeks	# 3	up 2	from # 5	192
James Paget University Hospitals NHS Foundation Trust	24.9 weeks	# 4	up 26	from # 30	0
North Bristol NHS Trust	24.8 weeks	# 5	up 11	from # 16	191
St George’s Healthcare NHS Trust	24.7 weeks	# 6	up 2	from # 8	298
Royal Devon and Exeter NHS Foundation Trust	24.6 weeks	# 7	down 4	from # 3	0
Mid Staffordshire NHS Foundation Trust	24.4 weeks	# 8	up 5	from # 13	15
Guy’s and St Thomas’ NHS Foundation Trust	23.7 weeks	# 9	down 5	from # 4	413
Surrey and Sussex Healthcare NHS Trust	22.6 weeks	# 10	down 3	from # 7	75
Royal National Orthopaedic Hospital NHS Trust	22.6 weeks	# 11	up 1	from # 12	3
University College London Hospitals NHS Foundation Trust	22.5 weeks	# 12	up 9	from # 21	284
Croydon Health Services NHS Trust	22.5 weeks	# 13	down 7	from # 6	2
Barts and The London NHS Trust	22.3 weeks	# 14	up 4	from # 18	154
King’s College Hospital NHS Foundation Trust	21.2 weeks	# 15	down 4	from # 11	205
Basildon and Thurrock University Hospitals NHS Foundation Trust	20.8 weeks	# 16	up 9	from # 25	8
Bradford Teaching Hospitals NHS Foundation Trust	20.8 weeks	# 17	down 3	from # 14	0
North Middlesex University Hospital NHS Trust	20.7 weeks	# 18	up 32	from # 50	107
Royal Berkshire NHS Foundation Trust	20.5 weeks	# 19	down 4	from # 15	0
University Hospital Southampton NHS Foundation Trust	20.3 weeks	# 20	up 4	from # 24	104

 

Congratulations to Bolton NHS Foundation Trust for dropping off the table from 9th to 69th position, with a reduction in 92nd centile incomplete pathways waits from 23.7 to 17.0 weeks; and to Royal United Hospital Bath NHS Trust who fell from 10th to 48th place with a reduction from 23.0 to 17.8 weeks.

The next 18-weeks statistics release from the Department of Health is expected at 9:30am on Thursday 21 June 2012.

Well, does it? Here’s the evidence. You can see on the chart the steady reduction in outpatient and inpatient long-waits in the early noughties, followed by the dramatic cut in referral-to-treatment long-waits from 2007 to 2009.

GP referrals are used to indicate the level of demand, and they rise in two steps over the period. The first step doesn’t line up with the long-wait events, but the second step does coincide quite nicely with the achievement of 18 weeks.

Although it doesn’t look like much on the chart, the increase from mid-2007 is a 22 per cent step up in GP referrals over two years, which is not to be sneezed at (but hardly represents a spiralling out of control). Was it caused by the improvement in waiting times? Who knows; this is perhaps one for the health economists (who have various views on the subject).

Data sources: RTT data, inpatient and outpatient waits, GP referrals (recent), GP referrals (older) 

You’ve thrown the data in, picked an activity scenario, and now you want to see the results.

More than that, you’ve loaded up the entire hospital – a couple of hundred service lines in all. So you’re slightly dreading the massive table – over ten thousand numbers – that will make up your detailed plan for the coming year.

You needn’t have worried, because Gooroo Planner’s brand-new Report viewer makes it all digestible.

Want to see the biggest waiting lists? Just click the row you want to sort (or use the drop-down), and select your sort order.

Want to see Orthopaedics? Just type “ortho” into the filter box.

Want to subtotal across hospital sites and specialties to see the big picture? Just un-tick the headers you want to subtotal across.

Want to use all these features at the same time? No problem: just click Apply.

The new Report viewer means that chucking the numbers around is now a lot easier. So you can quickly pick out the detail that matters, without losing sight of the big picture. You get the power of a database, yet the controls are simpler than a spreadsheet.

To see this and everything else about Gooroo, just get in touch: email info@nhsgooroo.co.uk or phone 01743 232149.

Everybody knows that the last Labour Government brought waiting times down from 18 months (just for the inpatient wait) to 18 weeks (for the entire referral to treatment pathway); an amazing achievement that transformed patients’ experiences of the NHS.

Everybody also knows that the Coalition Government abandoned those targets, whereupon waiting times promptly shot up, so they re-introduced the targets and then waiting times, er… carried on going up, or came down again or something.

Time to look at the facts. The following chart shows the number of long-waiters who were still waiting at the end of every month, since referral-to-treatment records of the waiting list began in August 2007:

The scale of success in achieving the NHS Constitution targets (that 90% of admitted and 95% of non-admitted patients must be within 18 weeks) is clear. The number of long-waiters on the list was genuinely and dramatically reduced from millions to a few hundred thousand. The total number waiting was reduced too, but interestingly the improvement was efficiently confined to the long-waiting part of the list only, as the next chart shows:

To find out what happened after the NHS Constitution targets were met, let’s zoom in on those long-waiters:

After the targets were met, there was a catch-up period while the target was achieved “properly”. This took nearly a year and was finally achieved in June 2009. Although long-waits did improve a bit after that, the pace was much slower. The NHS heaved a collective sigh of relief and maintained the target position.

Then came the General Election, and the “abolition” of the targets (in fact, merely the ending of central performance management). The number of long-waiters over 18 and 26 weeks promptly went up a bit (very long waits over 39 and 52 weeks were not so much affected). Eventually the 18-week backlog reached the point where even the misleading NHS Constitution targets could no longer be held, and the headline target was breached for two months running.

That first winter was the post-election low point, and it led a few months later to the Government introducing (for the first time since referral-to-treatment targets were created) a new target to reduce long-waiters who are still on the waiting list. This was a good decision as it addresses the issue of long-waiting more directly. Even though the new waiting-list-based target only came into force at the start of April 2012, and is only partially implemented in this financial year, the Government has been swiftly rewarded with sharp reductions in long-waiters and the NHS breaking new records across the board.

The recent improvements, welcome though they are, seem rather small beer in comparison with the original achievement of 18 weeks. The gains made under Labour were so large; what could the Coalition Government do to match them? Plenty, in fact: as Anthony McKeever and I suggested in November, abolishing over-one-year waits would transform public perceptions of the NHS and correct a long-standing unfairness. And then… but perhaps we shall leave the other possibilities for another blog post.

All data from the Department of Health, via our monthly waiting times fact checker spreadsheet.