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Posts Tagged ‘reporting’

I have a puzzle for you: thousands of patients are apparently missing from the English waiting list. I don’t know where they are (though I’ll have a go at guessing), and I’m hoping some of you can help me.

Here’s the problem.

In principle, we should be able to start with, say, the 4-5 week waiters from the end-of-January waiting list, take away those patients who were admitted and non-admitted from the cohort during February, and (because February was exactly 4 weeks long) end up with an estimate of the 8-9 week waiters on the end-of-February waiting list.

That method would miss any patients who were removed without being seen or treated (for instance ‘validated’ patients who had been reported on the January waiting list in error), but that error should all be in one direction: to make the reported February figure smaller than our estimate. Patients cannot appear on the waiting list with several weeks on the clock out of thin air, can they? So our estimate, minus the reported end-of-February list, should always produce an anomaly that is positive and which reflects validation during February.

Sounds great. But if you actually do the sums you come across some oddities. Several, in fact, as you can see from the supposedly-impossible negative values in the chart below.

1) Missing very-short waiters

The first oddity is for the very shortest waiters. If you take the number of patients across England who have waited 1-2 weeks at the end of January, and knock off February’s admitted and non-admitted patients, then the expected number of 5-6 week waiters at the end of February should be no more than about 177,720. But in fact some 179,087 were reported in the end-of-February waiting list data: more than a thousand too many. That’s the small negative anomaly at 5-6 weeks in the chart above. A thousand-odd patients have appeared in the February figures out of thin air. Where did they come from?

They weren’t new referrals being treated immediately (they could only affect February’s 4-5 week cohort, which should really be part of this oddity as well). So they must only have appeared on the waiting list a week after referral. This, as far as I am aware, is quite common, because paper referrals are often graded for urgency by the consultant before being recorded on PAS, and this process can take as long as a week or two. So if that’s the explanation then that would explain the first oddity.

2) Missing 9-week waiters

The second oddity crops up at 8-10 weeks, and this is larger and more mysterious. At the end of January there were 233,003 patients on the waiting list who had waited 4-6 weeks since referral. After deducting the relevant admitted and non-admitted patients, you are left with an upper limit for 8-10 week waiters at the end of February of about 129,045. But in fact the reported figures show there were 144,434: some 15,389 too many, and causing the large negative anomaly in the chart. That’s a lot of patients suddenly appearing in the February figures. Where did they come from?

I don’t know the answer to this one, which is why I’m asking. But my guess is that this has something to do with cancer pathways. Could it be that some cancer patients are not being reported in the incomplete pathways statistics, but are being reported in the admitted and non-admitted figures? The NHS Standard Contract specifies that cancer patients should be treated within 62 days of referral, which is 9 weeks and coincides nearly enough with this anomaly. If large numbers of cancer patients are not being recorded in hospitals’ mainstream computer systems, which this explanation implies, then that in itself could be worrying because parallel and duplicate administrative systems can lead to patients getting lost.

3) Missing 17-week waiters

The third oddity is around 18 week waits. It isn’t large enough to appear as a negative anomaly in the national statistics charted above (though it does show as a step-change), but if you drill down to Trust level it does produce a negative anomaly for some individual Trusts. Because the cohort-tracking sums are inexact, and because quite a few Trusts crop up in this analysis, I am not going to name Trusts individually but instead will look at the overall pattern.

At some Trusts, the reported number of patients waiting 17-18 weeks at the end of February is higher than you would expect (a negative anomaly at Trust level), and they have no negative anomaly for 18-19 week waiters. In most cases the negative anomaly is small (or a small percentage). But in a handful of Trusts it does look significant; in other words significantly more patients are being reported just within the 18-week target than you would expect.

Again I don’t know what the explanation is, but my guess is that some Trusts (or some parts of some Trusts) might be applying clock pauses to their waiting list figures. That is strictly forbidden; the guidance says (emphasis in original):

“Clock pauses may be applied to incomplete/open pathways locally – to aid good waiting list management and to ensure patients are treated in order of clinical priority – however, adjustments must not be applied to either non-admitted or incomplete pathways RTT data reported in monthly RTT returns to the Department of Health.“

4) Disappearing 18-week breaches

The final oddity is just above the 18-week mark, and this anomaly goes in the opposite direction. From 18-22 weeks, the end-of-February waiting list is around half the expected size, so the anomaly is much more positive than expected.

My guess is that this is the result of waiting list validation being targeted at over-18-week waiters so that they don’t score against the admitted and non-admitted standards. This is a largely redundant tactic now that the main focus of the penalties, from April, is on incomplete pathways; Trusts today would be better advised to focus their validation efforts on patients approaching 18 weeks, rather than those who have already breached.

So there are four oddities in the data. If you can help explain any of them, or at least explain what is happening where you work, then do leave a comment below this post on the HSJ website (either anonymously or otherwise), or contact me in confidence by email or publicly on Twitter.

If you want to dive into the figures, you can download a spreadsheet that contains all the detailed calculations here.

POSTSCRIPT

A few more suggestions that have been put to me since I posted this:

Some missing waiters around the nine-week mark could be Choose & Book patients, who were told by C&B that no appointments were available and therefore raised an ASI (Appointment Slot Issue). Those patients might then be managed on paper by the hospital until their slot is arranged, which might take several weeks, during which they might not be reported as incomplete pathways. (Incidentally, this is a wasteful and risky administrative process, and the patient usually ends up in a similarly-dated slot to the one they would have had if C&B polling ranges had simply been extended.)

Some missing patients close to the 18-week mark at Trust level (though not at national level) are tertiary referrals. These arrive at the tertiary centre with time already on the clock (although there is now the option for the referring provider to take the ‘hit’ on any breaches caused by delays at their end: http://transparency.dh.gov.uk/files/2012/06/RTT-Reporting-patients-who-transfer-between-NHS-Trusts.pdf).

Here is a comment left at the HSJ website:

Anonymous | 2-May-2013 11:13 am

A few points come to mind in response to this article:
- As a general comment, early this (calendar) year, the impending financial penalties for >52 week waiters resulted in a flurry of activity to clear up waiting lists and address data quality issues. This almost certainly has created lots of apparent anomalies that are in fact data quality corrections.
- The >52 week penalties are contained in the standard NHS contract template – you will find that some CCGs have chosen not to include them in the final versions used for their providers. I think this may happen in situations where the provider is on a block contract. This is probably not a major factor though.
- My experience suggests that providers will not stop validating 18 week breaches against the clock stop targets – I am not sure any board or exec would simply not be worried about breaches that aren’t really breaches, financial penalty or not. It is still a core operational standard (as defined by the NTDA) so will still create a fuss if not achieved.
- as regards the missing very short waiters, grading for urgency by clinicans has definitley been known to take longer than 2 weeks. A less than one percent discrepancy could easily be explained by late grading and, probably more commonly, hospitals without single points of referral receipt not getting things on the system ina timely fashion e.g. letters going directly to med secs who sit on them for too long. If you know the patient won’t be seen for >10 weeks, why bother getting them on the system – this is the attitude in some cases at least!

Some of the differences between Scottish and English waiting times are pretty obvious. England has three 18-week referral-to-treatment targets and a 6-week diagnostic wait (pp.38 & 58), whereas Scotland has one 18-week referral-to-treatment target, a 6-week diagnostic wait, a 12 week inpatient/daycase Treatment Time Guarantee, and a non-legally-binding 12 week outpatient wait (p.5). Already we can see that it’s quite complicated in England, but even more complicated in Scotland.

If you dig into these targets you find the rules are different too. The differences are pretty big, and many patients who would have a right to short waiting times in England, enjoy no such guarantees in Scotland.

For instance, if you are referred to an English hospital then they have to accept the referral and treat you (unless they don’t provide that kind of care, or you agree to be treated elsewhere) (pp.7-8). But in Scotland the hospital can routinely send its patients just about anywhere it likes (p.16), even if the destination is way outside the boundaries of its Health Board; any patient who refuses can be taken off the waiting list or have their ‘clock’ reset to zero (p.17). In case you think that such long-distance transfers might be a rare event, Scottish Health Boards have regular arrangements to send increasingly large numbers of waiting list patients to the Golden Jubilee National Hospital west of Glasgow, even from as far away as Orkney (p.5).

You have to be ready at short notice in Scotland too, because the NHS considers seven days’ notice to be a “reasonable offer” (p.15), compared with three weeks in England (pp.34-35). (To protect urgent patients, hospitals can offer shorter-notice appointments in both nations, and patients are free to accept or reject them without penalty.)

And you should avoid changing your appointment in Scotland, even if you give them plenty of notice, because the hospital can use that as an opportunity to reset your clock to zero; if you change your appointment three times, they are normally expected to send you back to your GP (p.19). There are no such sanctions for changing appointments in England even if you give only short notice (p.28). In both nations, though, you can be taken off the list and sent back to your GP if you fail to attend your first outpatient appointment without giving notice (i.e. you ‘DNA’) (p.20, p.28).

If you are ever unavailable for treatment, either for medical or social reasons, then in Scotland your ‘clock’ is paused (p.22-25). This rule was very heavily applied (pp.10, 19) until a recent clampdown. In England the new main target (based on incomplete pathways: p.58) does not allow clock pausing at all, although clock pauses were certainly allowed and used against the previous main target.

Then there are patients who are completely excluded from the targets. For obvious reasons, both England and Scotland exclude obstetrics from their waiting time guarantees. If you are waiting for an organ transplant, then the wait for the organ itself is excluded in both nations. And if you want to become pregnant then assisted reproduction is covered in England, but not in Scotland. (p.13-4)

Both nations have short-wait guarantees for cancer outpatient appointments and initial treatment, but the English guarantee covers all cancers (pp.38-40) while in Scotland there are exclusions covering several cancer types (pp.15, 25-26). If you are having a course of cancer treatment then, in England, you are guaranteed your subsequent treatment within time limits, whether it’s surgery, chemotherapy or radiotherapy (pp.39-40); but there are no such guarantees in Scotland (p.5).

There are different exclusions in diagnostics as well. Scotland applies the 6-week guarantee only to eight key diagnostic tests (p.14), which means that English (but not Scottish) patients are guaranteed a 6-week wait for DEXA and various kinds of physiological measurement (p.8). However in both nations the diagnostic wait is part of the 18-week referral to treatment wait, so this may not make a massive difference in practice.

Why are the English rules apparently so much more patient-friendly and inclusive than the Scottish ones? I think the answer was right at the start: the nature of the waiting times targets.

In England, the overall targets have a tolerance, for instance that 92 per cent of patients on the waiting list must be within 18 weeks. That leaves an 8 per cent margin for the odd exceptions (and there will always be exceptions).

In Scotland, though, the legally-binding 12 week Treatment Time Guarantee is a 100 per cent target. There will still always be exceptions, so they must be allowed for in the rules; which means you need lots of rules.

Personally, I think the English approach is the better one. (And in case anyone north of the border is starting to suspect a national bias, I should say that I am Scottish and was born and brought up in Scotland.) Hard cases make bad law, and trying to define all the reasonable exceptions in the rules is inevitably going to be complex and imperfect. Better simply to allow a tolerance in the target and let the rules include everybody.

Of all the referral-to-treatment (RTT) waiting times targets, the toughest is currently the “90 per cent” target. This requires 90 per cent of patients to have waited less than 18 weeks as they are admitted, on an adjusted basis. Adjusted, that is, for clock pauses.

I must confess, I had always assumed that clock pauses have only a minor effect. There might be one or two Trusts, I thought, where clock pauses were (shall we say) giving the adjusted admitted target a fair wind. So I was really quite taken aback when I looked at the evidence.

Clock pauses are only allowed in limited and defined circumstances. According to the RTT Rules Suite (p.22, my emphasis):

Clocks may only be paused for patient initiated delays at the admission for treatment stage of the waiting time pathway.

Once a decision to admit has been made, patients should, of course, be offered the earliest available dates to come in, as appropriate. However, where patients decline these offers, then, for a clock to be paused, they must be offered at least 2 reasonable dates for admission. Reasonable is defined as an offer of an appointment with at least 3 weeks notice.

Not much scope, you might think, for widespread pausing, or for provider-initiated pausing to help achieve the target. So how much are clock pauses actually used, and what effect do they have on adjusted admitted waiting times?

In the following chart, each point represents one specialty at one Trust, and it shows all Trust-specialties where at least 50 patients were admitted during June 2012. The position along the x-axis shows the 90th centile adjusted admitted RTT waiting time; i.e. the waiting time exceeded by only 10 per cent of patients, measured from referral to admission with clock pauses deducted. The position up the y-axis shows how much time was deducted for clock pauses, compared with the 90th centile unadjusted admitted RTT waiting time.

Do you think that an alien, looking at this chart, might be able to guess what the adjusted admitted target is?

You have to admire the accuracy with which so many services are achieving 18 weeks, with exactly the right amount of clock pausing.

It is also striking how much more common clock pauses are, in those services that are only just achieving the 18 week target. For services that lie between 17 and 18 weeks, some 42 per cent include at least one week of clock pauses; for the rest, the figure is just 24 per cent. Looking at it another way, the 17-18 weekers include an average 1.5 weeks of clock pauses, and the rest just 0.7 weeks.

Let’s drill down into one specialty in one Trust where the impact of clock pauses is especially clear. In the chart below, the unadjusted admissions are shown by the solid red columns, and the adjusted admissions by the solid red line (data from the Department of Health).

The gap between the line and the columns shows the net number of clock pauses: i.e. the number being paused minus the number coming off pause. There are no net pauses at all below 15 weeks, then 39 net pauses between 15 and 18 weeks, and then above 18 weeks they all start coming off pause again.

If this service had paused only 37 patients instead of 39, it would have failed the target. By a remarkable coincidence, it has achieved the target by a similarly narrow margin every single month for the last three years; the extent of clock pausing varies, but the adjusted result remains the same.

I am not making a blanket accusation that any service, that narrowly achieves the adjusted admitted target with just the right level of clock pauses, is misusing clock pauses in order to achieve the target. But I think it is fairly clear that some of them probably are, and some systematically.

Does it matter? Yes, but not as much as it used to, because the recently-introduced incomplete pathways target does not allow clock pauses to be deducted. If that target ever achieves the primacy it deserves over the adjusted admitted target, then pauses will become largely irrelevant. Normal levels of patient-initiated pauses (which, as we saw in the first chart, do not have a big impact on waiting times) will be absorbed within 18 weeks and the 8 per cent tolerance on incomplete pathways.

Even as the targets stand today, any service with a very high level of clock pauses will still breach the incomplete pathways target (as the example above does). Unless, of course, a service decides to adjust the incomplete pathways for pauses too. That isn’t allowed, but it does happen; how else could you explain the chart below, in which long-waiting patients are apparently being admitted even though there are no long-waiting patients on the list (and weren’t the month before, either)?

 

(The Department of Health has just published the checks they run across all the monthly RTT data submitted by Trusts, including checks on clock pauses. You can download the document “RTT Assurance Data Checks (PDF, 54K)” here.)

Here is the local picture on 18 week waits, fully updated with the June 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.

Imperial College Healthcare NHS Trust is in the news, with startling reports of a breakdown in record-keeping that resulted in patients waiting up to 2-3 years. Some of the patients who got lost in the system were suspected cancer referrals who the Trust is still trying to locate, months or even years later. It has been a horrible, stomach-churning failure.

To their credit, Imperial seem to be sorting things out pretty quickly: fixing the data, validating the waiting list, following up patients they are concerned about, clarifying scheduling procedures, and strengthening planning, all with external assistance and oversight. I don’t have inside knowledge of the actions they are taking, but it does look from the outside as if they are doing what you would expect.

Looking more broadly, how could the NHS become more resilient against this kind of failure? How can we make sure it never happens again and, if it does, that it is caught much more quickly to limit the damage?

Ultimately the answer is for any kind of waiting list to be regarded culturally as a sign of failure by the NHS, and to make involuntary waiting a thing of the past. But well before we reach that happy state there are more immediate and practical things we should do:

The first step is to simplify dramatically the reporting and targeting of waiting times. In common with most Trusts, Imperial’s scorecard in November 2011 (the last before their reporting break) tracked no fewer than eleven measures relating to the 18 week targets. Only one of those measures related to long-waiters still on the waiting list, and it was the second from last item. What were the other ten? Eight related to other waiting times targets set by the Department of Health, and the remaining two were Trust measures that simply tracked the numbers of patients being treated.

This proliferation is completely unnecessary. Get the waiting list right, and all the other measures take care of themselves. The Department of Health accepts the logic of scrapping the admitted and non-admitted targets, so let’s just do it. Then Imperial and everyone else can boil their 18 week reporting down to a single measure: the 92nd centile waiting time for incomplete pathways, so that Boards can see right away when things are going pear-shaped.

The second is to put an end to one-year waits. Patients don’t know where they stand with a 90 per cent guarantee (they are left wondering: am I one of the 10 per cent?). But if they know that nobody waits longer than a year then something is definitely wrong if they have. A one year limit works for hospitals too: if no patient ever waits longer than a year then systems are unlikely to slip for more than a few months (at the outside) before someone notices.

Thirdly, we can improve the tracking and management of the most important patients on the waiting list: no, not the imminent 18-week breaches, I mean patients with a high clinical urgency. There is a data field in each PAS system for recording the urgency of every patient on the waiting list: two week wait, urgent, or routine;  but in many hospitals this field is poorly used. Using it consistently would strengthen waiting list management and reduce the risk of urgent patients being delayed.

Finally, and in the longer-term, we can increase resilience by strengthening patients’ expectations and involvement during their waits. To their credit, the Government have made a start on this with the Operating Framework requirement to publicise to patients the 18 week guarantee. But these generalities are not specific enough: even BT do better, with regular personalised text updates on the escalation and fixing of the fault on your line. If patients were kept closely in touch with progress on their appointments, then they would be better placed to catch the ball if it dropped. The usual system of fire-and-forget referrals, “you’ll get a letter” hand-offs, centralised complaints procedures, and all the rest is too distant and siloed and we can surely involve patients in a more predictable and personal service.

How pressing is all this? Around England, and particularly in London, there are plenty of hospitals reporting dozens (even hundreds) of patients still waiting more than a year after referral. How sure can we be that nothing similar is happening at any of them, or that none of those patients are waiting even longer than the 2-3 years found at Imperial?

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.

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.

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.