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Archive for the ‘Waiting time targets’ Category

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.

So, is NHS performance on waiting times, “strong” or an “embarrassment”
(@HSJEditor via Twitter)

How did the HSJ (“NHS reports strong performance on 18 weeks targets”) and the Guardian (“Number of NHS patients waiting over 18 weeks for treatment up 27%”) manage to draw opposite conclusions from the same waiting times statistics?

The Guardian explained its numbers thus:

A total of 26,417 people in England waited more than 18 weeks to be treated in February this year compared to 20,662 in May 2010, when the government was formed – a 27% rise.

Looking at the data (spreadsheet here), we can see where those figures came from. 26,417 is the number of patients admitted as inpatients and daycases, during February 2012, who had waited over 18 weeks (adjusted for clock pauses) before being treated. 20,662 is the corresponding figure for May 2010, the month of the General Election.

That’s a 27.9 per cent increase. But an increase in what? Not in the “number of NHS patients waiting”: if you look at the waiting list figures (the so-called “incomplete pathways”), you find that the number of over-18-week waiters still on the waiting list fell by 16 per cent over the same period, from 209,411 to 175,549 (which, as it happens, is an all-time low).

No, the increase was in the number of over-18-week waiters being treated, and at this point we need to remind ourselves that treating long-waiting patients is a good thing (and certainly much better than leaving them on the waiting list). The NHS in England has recently been treating a lot more long-waiters in an effort to clear the over-18-week backlog: in the year to February 2012 some 337,264 over-18-week waiters were admitted (9.3 per cent of all admissions), compared with only 283,128 (7.8 per cent of admissions) in the previous 12 months.

So the Guardian headline needs a bit of adjusting. Using the same figures it could have said “Number of NHS patients treated after waiting over 18 weeks up 27%”. Or, to put the focus on “NHS patients waiting”, it might have read “Number of NHS patients waiting over 18 weeks for treatment down 16% to record low”. Either way, it’s hardly “a huge embarrassment”.

A similar confusion over the figures popped up elsewhere this week, with the CQC’s large-scale survey of inpatients reporting that waiting times had gone up. Again, the figures show that the number of long-waiters picked up in the inpatients survey had increased, which again is a measure of long-waiters being treated not of long-waiters still waiting.

What is surprising about the inpatient survey is the very high proportion (14 per cent) reporting that they had waited longer than six months, when according to the national RTT statistics the figure for the same period (October 2011 to January 2012) was only 3 per cent. Perhaps the answer lies in the wording of the question: according to the summary report “the survey asked respondents how long they had to wait to be admitted to hospital, from the time they first talked to a health professional about being referred for a hospital admission”. This isn’t quite the same as the waiting time from referral to treatment, which may (or may not) explain the difference.

So what’s the verdict: “strong”, or an “embarrassment”? Looking at the waiting list, in February 2012 the numbers of patients waiting longer than 18, 26, 39 and 52 weeks were the lowest ever recorded. So were the 90th, 92nd and 95th centile waiting times. So (not that it means very much) were the mean and median waiting times. A “strong” performance? I hope we can all agree that it is.

Here is the local picture on 18 week waits, fully updated with the February 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 NHS in England met all its 18-week waiting times targets again in February, consolidating January’s first-ever success on all three measures. Although long-waits are improving in the run-up to April’s new target, the overall number on the waiting list remains unchanged compared with recent years.

The number of over-one-year waiters on the waiting list fell again to a new record low, but progress is slowing as the blitz on validating long-waiters runs out of steam. Sure, 5,696 over-one-year waiters is a lot better than 14,880 the year before, but it’s still 5,696 too many. When the NHS admits 50 times as many patients every month, why are these patients still on the waiting list? Also, why are so many (2,132) in London?

For all the stats and time trends, you can download our updated waiting times fact checker here.

Imperial are still on a reporting holiday, but we welcome the Robert Jones and Agnes Hunt orthopaedic hospital back to the data series (minus the suspicious hill in the middle of their waiting list); it is much better to have those one-year-waiters where everybody can see them, than to risk them dropping out of sight and out of mind.

Apart from that there are the usual caveats: the data excludes patients who are being held up by referral restrictions, and backlogs that may be building up for post-treatment follow-up.

England-wide picture

Both admissions and the total list size continue to track the trajectories of recent years. No sign of austerity hitting overall activity, nor of the NHS reducing waiting lists below their current level.

The new target, that 92 per cent of the waiting list (incomplete pathways) must be below 18 weeks RTT, starts  in April. At national level the NHS achieved it ahead of time in January, and has continued this improvement in February.

All major specialties reported improvement against this measure, except Orthopaedics which roughly maintained its position.

The new target must be met in every specialty and in every NHS organisation and, although more services are getting there, some 28 per cent of Trust-specialties are still below target. Expect this number to improve sharply over the next two months as Trusts scramble to avoid the “performance management” thumbscrews.

 

Trust top twenty

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

Trust	92% of waiting list is within	Position in February	Change	Position in January	Over-one-year waiters on list
The Robert Jones And Agnes Hunt Orthopaedic Hospital NHS Foundation Trust	35.4 weeks	# 1	no data	no data	63
Royal Devon and Exeter NHS Foundation Trust	27.7 weeks	# 2	no change	from # 2	0
Guy’s and St Thomas’ NHS Foundation Trust	25.7 weeks	# 3	no change	from # 3	457
Pennine Acute Hospitals NHS Trust	25.0 weeks	# 4	up 5	from # 9	138
Croydon Health Services NHS Trust	24.2 weeks	# 5	up 2	from # 7	93
Surrey and Sussex Healthcare NHS Trust	24.0 weeks	# 6	no change	from # 6	86
St George’s Healthcare NHS Trust	23.9 weeks	# 7	up 32	from # 39	419
Bolton NHS Foundation Trust	23.7 weeks	# 8	up 2	from # 10	102
Royal United Hospital Bath NHS Trust	23.0 weeks	# 9	up 11	from # 20	5
King’s College Hospital NHS Foundation Trust	22.8 weeks	# 10	up 7	from # 17	242
Royal National Orthopaedic Hospital NHS Trust	22.7 weeks	# 11	up 8	from # 19	1
Mid Staffordshire NHS Foundation Trust	22.1 weeks	# 12	down 11	from # 1	7
Bradford Teaching Hospitals NHS Foundation Trust	21.9 weeks	# 13	up 2	from # 15	0
Royal Berkshire NHS Foundation Trust	21.9 weeks	# 14	down 2	from # 12	0
North Bristol NHS Trust	21.9 weeks	# 15	up 10	from # 25	125
Warrington and Halton Hospitals NHS Foundation Trust	21.6 weeks	# 16	down 5	from # 11	40
Barts and The London NHS Trust	21.5 weeks	# 17	up 5	from # 22	51
Taunton and Somerset NHS Foundation Trust	21.4 weeks	# 18	down 10	from # 8	8
Hampshire Hospitals NHS Foundation Trust	21.3 weeks	# 19	up 5	from # 24	37
University College London Hospitals NHS Foundation Trust	21.3 weeks	# 20	up 8	from # 28	263

 

Congratulations are in order to the following Trusts for dropping out of the table altogether with big reductions in long-waits: Weston (whose 92nd centile fell from 24.9 to 16.9 weeks); Great Ormond Street (25.5 to 20.1), and Staffordshire and Stoke on Trent Partnership (with a whopping 23.4 to 12.1 week reduction).

The next 18-weeks statistics release from the Department of Health is expected at 9:30am on Thursday 17 May.

Usually when Celtic nations borrow ideas from the English, they pick the best bits and leave the not-so-good stuff behind. Not this time. Scotland has just “achieved” its first 18-weeks referral-to-treatment (RTT) target, but this success is an illusion. Behind a distorting target, long-waits are shooting up at an astonishing rate.

As if that isn’t bad enough, the NHS in Scotland is also enduring a torrent of headlines about the Lothian waiting times scandal, with lurid tales of inappropriate offers, staff suspensions, fiddles, and bullying. Anyone outside Scotland, wanting to see from a safe distance just how nasty a waiting list scandal can get, should take a look (before checking out the antidote here).

How did it go so wrong?

Fundamentally, Scotland picked the wrong target. It copied the headline English target (that 90 per cent of completed patient journeys must be within 18 weeks RTT, adjusted for periods of patient unavailability). As in England, any Health Board can achieve the target simply by refusing to treat patients who have already passed the 18-week mark. And that, it seems, is exactly what has happened.

The Scottish Government wanted the 90 per cent target met by December 2011, and right on cue the NHS achieved 92 per cent. But they achieved it by suppressing the number of long-waiters being treated to a record low (figures from Table 1 here):

This would be fine, if it were genuinely the result of having fewer long-waiters still on the waiting list. But the opposite is true. We cannot make a direct comparison on a RTT basis because (unlike England) Scotland does not publish RTT figures about the waiting list itself. But there is data available for the separate outpatient and inpatient/daycase stages of the patient journey, and the official charts (reproduced below) could hardly show more starkly how the number of long-waiting patients still on the list is going up like a rocket.

It doesn’t look any prettier in raw numbers. Year on year, the number of patients still on the waiting list over 12 weeks went up from 1,769 to 6,141 for new outpatients, and from 210 to 2,019 for inpatients and daycases. The big numbers are concentrated in Lothian (as patients wrongly declared “unavailable” are returned to the waiting list), but there are sharp increases in other Health Boards too, showing that this is not a Lothian-specific phenomenon.

It is such a pity. These outpatient and inpatient/daycase targets, which apply to patients who are still on the waiting list, were meant to be the magic bullet that would stop backlogs building up, and stop the Scottish referral-to-treatment target from distorting waiting times as they did in England. But the backstop has failed. The distorting target won, it prevents Health Boards from treating enough long-waiters, and so the number of long-waiters still on the waiting list is going up.

Are there any plans to sort this out? The Scottish Government will take half a step in the right direction, with a 12 week legal guarantee covering some inpatients and daycases due to start in the autumn. But putting a small patch on a weakened backstop will not fix the underlying problem.

Instead, Scotland should look across the border and learn again from England’s mistakes. The new English target is the one to copy: that 92 per cent of patients still waiting must be below 18 weeks, on a referral-to-treatment basis and without adjustment for patient unavailability.

Even better, Scotland could do it first. Although English Health Ministers have accepted the logic of a waiting list based target, and gone to all the trouble of creating one, they have bizarrely delayed its full implementation until at least April 2013. Scottish Ministers could switch targets now, and rapidly achieve and sustain the genuine short-waits that they wanted in the first place.

We’ve crunched all the numbers, turned them into maps and charts… and here it is: all the local detail on 18-week waits around the English NHS.

The maps below are for all specialties combined, but if you want the specialty-level picture then you will find all the detail here for every Trust (Provider basis) and every PCT (Commissioner basis): nhsgooroo.co.uk/reports/

First, where are the long-waiters? They may have fallen to record lows nationally, but there are still Trusts with plenty of patients still waiting over a year. Click through to the map, and then click on any pin to see how the one-year and 18-week positions have changed year-on-year.

If you want to see how long people are waiting who live in your area, then the next map is for you. It’s Commissioner-based, so it relates to the population of each PCT.

 

What if you are an NHS manager, and want to sort out your long-waits and achieve the new “92 per cent of incomplete pathways within 18 weeks” target? The next two maps might help. Click on the pins to see how much work you would have to do a) to “chop the tail off the waiting list”, and b) an estimate of how much work it would take if you first improved patient scheduling.

First, achieving the 92 per cent target, by Trust (Provider basis):

…and by PCT (Commissioner basis):

 

The NHS in England continued its winning streak on waiting times, with record-breaking performance showing through on the latest (January 2012) figures. It’s an impressive result, especially for the middle of winter. The NHS notched up:

• The smallest overall waiting list since February 2010
• The smallest ever number of patients on the waiting list over 18 weeks
• The smallest ever numbers on the list over 26 weeks, 39 weeks, and 52 weeks
• Total and long-waiters on the list down on 3, 6, and 12 months ago, and since General Election.

The new (better) 18-week target, that 92 per cent of the waiting list must be within 18 weeks, was also met for the first time. In January 2012 92.3 per cent of the waiting list was below 18 weeks, beating the previous record set at the time of the General Election (91.9 per cent in May 2010).

You can download our updated waiting times fact checker here: Gooroo NHS waiting times fact checker

Caveats? Yes. The main standing caveat is that GP referrals are being limited in some areas, and this may be holding up patients before they appear on the waiting list. There is also a specific issue with the January 2012 data, because two Trusts (Imperial, and the RJAH Orthopaedic) again failed to submit data. However, even if you add those Trusts’ November 2011 figures back in, and make a guesstimate of the true long-wait position at the RJAH Orthopaedic, the 92 per cent target is still met England-wide.

Is there any bad news?

Well, you could point to the number patients admitted, who had waited over 18 weeks on admission; that is up since the General Election. But treating long-waiters is a good thing, surely; better than letting them wait. So a better criticism might be that the NHS treated (very slightly) fewer over-18-week waiters than a year previously (though the numbers are so small that the absence of Imperial and RJAH would tip it).

Or you could point to median waits being up since the General Election, on all three measures (admitted, non-admitted, and incomplete pathways). But then you’d have to explain whether that was really a bad thing, given that rising median waits could indicate less queue-jumping by non-urgent patients.

[UPDATE: As it happens, Andy Burnham MP, Labour's Shadow Health Secretary, did make exactly those two points, a couple of hours after this blog post was first published on the HSJ website.]

Or you could go for the proportion of Trust-specialties who are achieving the new 92 per cent waiting-list-based target: this was 71 per cent in January, which is below the 75 per cent peak set at the time of the General Election (see chart below). Perhaps that might be the one to aim for.

So, bad news? Not so much.

 

England-wide picture

Admissions from the waiting list were up, mainly because January had 21 working days this year and there were only 20 last year and the year before.

The total number of patients on the waiting list continues to track the seasonal trend with uncanny accuracy.

The new and better target, that 92 per cent of the waiting list must be within 18 weeks, has been met for the first time. Performance is also much better than normal for a January, and the new emphasis on long-waits still waiting is clearly having an effect.

At specialty level, all the big surgical specialties are heading in the right direction too. Neurosurgery continues to worry; it has long been the most-pressured specialty, and is currently drifting slowly in the wrong direction.

In 2012-13 the 18-week targets will need to be met in every specialty in every Trust, and the next chart shows how many of the 2,236 Trust-specialty combinations that have a decent volume of work are succeeding. The success rate has ticked up nicely, but still falls short of the record set at the time of the General Election.

 

Trust top twenty

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

Trust	92% of waiting list is within	Position in January	Change	Position in December	Over-one-year waiters on list
Mid Staffordshire NHS Foundation Trust	32.2 weeks	# 1	no change	from # 1	150
Royal Devon and Exeter NHS Foundation Trust	30.4 weeks	# 2	up 4	from # 6	0
Guy’s and St Thomas’ NHS Foundation Trust	28.2 weeks	# 3	up 2	from # 5	522
Great Ormond Street Hospital for Children NHS Trust	25.5 weeks	# 4	up 6	from # 10	37
Weston Area Health NHS Trust	24.9 weeks	# 5	up 12	from # 17	0
Surrey and Sussex Healthcare NHS Trust	24.8 weeks	# 6	up 3	from # 9	107
Croydon Health Services NHS Trust	24.8 weeks	# 7	up 6	from # 13	86
Taunton and Somerset NHS Foundation Trust	24.5 weeks	# 8	down 4	from # 4	12
Pennine Acute Hospitals NHS Trust	24.2 weeks	# 9	up 2	from # 11	110
Bolton NHS Foundation Trust	23.7 weeks	# 10	up 6	from # 16	162
Warrington and Halton Hospitals NHS Foundation Trust	23.7 weeks	# 11	up 1	from # 12	48
Royal Berkshire NHS Foundation Trust	23.5 weeks	# 12	up 2	from # 14	0
Staffordshire and Stoke on Trent Partnership NHS Trust	23.4 weeks	# 13	down 10	from # 3	71
Derby Hospitals NHS Foundation Trust	23.2 weeks	# 14	up 4	from # 18	0
Bradford Teaching Hospitals NHS Foundation Trust	22.7 weeks	# 15	up 13	from # 28	0
North Cumbria University Hospitals NHS Trust	22.3 weeks	# 16	up 5	from # 21	74
King’s College Hospital NHS Foundation Trust	22.1 weeks	# 17	up 68	from # 85	218
North West London Hospitals NHS Trust	21.9 weeks	# 18	up 12	from # 30	125
Royal National Orthopaedic Hospital NHS Trust	21.9 weeks	# 19	up 13	from # 32	1
Royal United Hospital Bath NHS Trust	21.9 weeks	# 20	down 5	from # 15	16

Congratulations are in order for Wirral University Teaching Hospital NHS Foundation Trust. Last month they were at number 2, now they have sorted things out and dropped off the table completely.

 

The next Department of Health 18-weeks data release (February 2012 figures) is scheduled for 9:30am on Thursday 19th April 2012.

Polly Toynbee’s piece on waiting list fiddles attracted a lot of attention, and quite right too. Within hours of being published, it was even being mentioned in the House of Commons at Health Questions.

Toynbee reported that:

The national target says 90% of patients must be treated within 18 weeks of first referral

and this has unpleasant consequences. A waiting list clerk, who resigned on principle, said:

She was told to cancel operations for anyone who was already waiting over 18 weeks, and instead to fill that theatre time with people closest to breaching the 18-week limit.

and

She was told not to book anyone already in breach until April and the start of the next financial year, or to book only one for every nine still under the target. Instead she was told to fill theatre slots with as many short, minor operations as possible.

This happens. It shouldn’t, but it does. The immediate and natural reaction is to blame the managers who gave the orders, but they are also just pawns in the game.

Imagine you are responsible for delivering the target for surgery in an acute general hospital. It’s now late February, so all the operating lists are nearly full for March, and new bookings are being made into April.

Let’s say you have booked 1,000 patients in March; 895 will have waited 18 weeks or less on the day of their operation, and 105 will have waited more than 18 weeks. The target says that 90 per cent must have waited less than 18 weeks, and you are heading for failure with only 89.5 per cent. What do you do?

You don’t have many options. If you breach the target, your Trust may receive a heavy fine from commissioners under the standard NHS Contract, and be subject to “performance management” by the SHA or Monitor; and you personally may be summoned to “explain yourself” to the Director of Operations or Chief Executive. Not an attractive option.

Or you could book in some extra under-18-week patients to bring performance up to 90 per cent. But that means finding operating time for 50 extra patients, and your lists are already nearly full. To make matters worse, you have used this tactic before and are running out of minor operations to pad out the target. Finances are tight, and you can’t afford to pay extra for lots of Saturday lists. So this option is not attractive either (and by using this option in the past, you have made today’s problem worse because your waiting list is now skewed towards heavier cases).

Which makes you think: you’re only 5 patients adrift of the target. If you just put 5 long-waiting patients off until April, and recycle their operating time for shorter-waiting patients, then you’re done. If you can choose five patients who are just about to breach 18 weeks then you have headed off your next problem too…

You can see how easy it is. Yes, it’s wrong, but in the circumstances what else can you do?

Following the story up at national level, Toynbee said: “Professor John Appleby of the King’s Fund health thinktank says he hears of waiting-list cheating from many hospitals and will suggest the National Audit Office investigates” and she asks whistleblowers to get in touch with her. Both are excellent ideas.

But we need to take care not to turn this into a punitive witch-hunt against cheating hospitals, because the targets and associated performance management are the root causes. So instead of prolonging the damaging treatment-based waiting time targets for another year, let’s abandon them now and move straight to the new waiting-list-based target instead. That, at a stroke, would eliminate the main cause of the problem.

Last month I highlighted the case of a Trust’s Orthopaedic patients, whose waiting time clocks seemed to be mysteriously stuck just below 18 weeks. It was not clear how this was happening, and now we are completely in the dark because they have stopped submitting data.

Then last week, while analysing the December release of 18-weeks data, I spotted a similar pattern at a different Trust. Here are the 2011 waiting list snapshots (i.e. the incomplete pathways data) for Orthopaedics at Salisbury NHS Foundation Trust.

Again, there is a peak in the number of patients waiting just below 18 weeks. Again, this peak does not move forward in time as each successive month goes by; you might expect the peak to move forward by one month, every month. And where do the patients in the peak come from? If these were patients just feeding through the list and then being treated in the usual way, you would see a plateau (where patients were not being treated) followed by a cliff (where they were), not a peak sticking up suddenly in the middle of the waiting list.

So it looks, on the face of it, as if patients in the peak are having their waiting times frozen somehow. According to the RTT waiting times rules, clock pauses are allowed under certain circumstances when measuring adjusted admitted pathways, but there is no provision for pauses in either the non-admitted or incomplete pathways data. So it is difficult to understand how a static peak, in the incomplete pathways data shown above, is possible under the rules.

Whatever Salisbury were doing in Orthopaedics in 2011, it was successful in narrowly achieving the headline target that 90 per cent of adjusted admitted patients should be within 18 weeks. When I say narrowly, I mean that in each of those 12 months their performance stayed in the range 17.962 weeks to 17.999 weeks (and was within two patients of failure on 7 of those months).

It is impossible to tell exactly what is going on, just by looking at these figures. If there is an innocent explanation then I would like to hear it. But if there isn’t, then I would hesitate to lay all the blame at the Trust’s door, because the target that is being so narrowly achieved is perverse. The system of harsh penalties and “performance management” surrounding it has the effect of coercing Trusts into doing bad things.

So if any changes in counting methods do turn out to be needed in Salisbury, it would be good to see commissioners and performance managers exercising restraint to allow the Trust to deal with any backlogs openly. Above all, it should not be forced into taking a ‘reporting break’. There are too many of those going on at the moment already.

Here are some resources to help you analyse the RTT waiting times pressures in your local area.

You can look up any Trust or PCT, any specialty, and get a detailed analysis with peer comparisons and time trends here: nhsgooroo.co.uk/reports (free registration required).

If you are managing towards the new target (that 92 per cent of the waiting list must be within 18 weeks), then these maps show the scale of the pressures. You can click any organisation to get more detail in a balloon.

If you want raw data on the number of patients waiting, both in total and for long-waiters, with year-on-year comparisons, then the next two maps have all that. You can access them by Trust and by Commissioner. On these interactive maps, the pin colours show the number of one-year waiters.