NHS health boards across the Midlands are deliberately making patients wait around three months for non-urgent treatment, an investigation by the British Medical Journal (BMJ) has found. The analysis revealed that integrated care boards (ICBs) in England have introduced minimum waits of up to 16 weeks for hip, knee and cataract surgery or other planned procedures as a way of managing demand and controlling costs.
Using the Freedom of Information Act, the BMJ obtained data from 35 out of 36 ICBs in England. Of those, 17 had introduced minimum waits of between 12 and 16 weeks for key procedures. Birmingham said it had a "minimum wait for first definitive treatment of 14 weeks for planned/non-urgent elective care, unless there was clinically verifiable urgency demonstrated by the provider". NHS Hereford and Worcestershire said it had "activity planning assumptions" which had "a minimum waiting time of 14 weeks" for planned procedures. Shropshire said it had "implemented a minimum waiting time threshold of 16 weeks" for all routine procedures to "promote fairness, reduce variation, and ensure all patients receive timely and equitable access to elective services".
Concerns from surgical and GP leaders
The Royal College of Surgeons (RCS) said it was "concerned by the scale" of measures that could leave patients suffering in pain, while GP leaders said the waits were "difficult to justify". Other ICBs have introduced minimum waits in areas such as cataract surgery (16 weeks in some places), and others said they had a "planning assumption" that patients will be forced to wait several months.
Tim Lane, president of the Royal College of Surgeons of England, said: "We recognise the significant financial and capacity pressures facing the NHS, but patients who are clinically ready for treatment should not be deliberately made to wait. Unnecessary delays can prolong pain, limit mobility, increase anxiety and allow conditions to deteriorate. Access to treatment should be determined by clinical need, not where a patient lives. Widespread use of minimum waits risks creating a postcode lottery and further delaying care. Minimum waits are not a substitute for addressing the NHS's underlying capacity problems. We need increased capital investment, improved infrastructure and better use of existing capacity so patients receive their treatment as promptly as possible."
Impact on general practice and patients
Prof Victoria Tzortziou Brown, president of the Royal College of GPs, said: "Long waits for hospital treatment can be frustrating for patients, particularly when they are living with pain or other symptoms that are affecting their day-to-day lives. During this time, patients often turn to their GP for support and ongoing management, so longer waits can also add to the already intense workload pressures facing general practice. We understand the enormous pressures facing hospitals and the capacity constraints that can lead to long waits, but decisions about when a patient receives treatment should be based on their clinical needs. Blanket minimum waiting times that require patients to wait longer than clinically necessary for administrative or financial reasons are difficult to justify, particularly where patients could otherwise be treated sooner. At a time when the NHS is trying to bring waiting times down, we should be doing everything possible to ensure patients can get the care they need without unnecessary delays."
Policy analysts and NHS response
Sally Gainsbury, senior policy analyst at the Nuffield Trust think tank, told the BMJ: "Limiting activity by a certain minimum waiting time can be an equitable and rational response to making sure your budget is spread evenly across your population." But she added: "I'm concerned there isn't clarity on how to do this fairly."
An NHS spokesperson said: "While commissioned wait policies help the NHS make the best possible use of its services, staff and budgets – all patients are seen in order of clinical need. We recognise any wait for treatment can be difficult for patients, and we would not expect any organisation to commission waits that risks breaching NHS Constitution standards, which set an 18-week maximum wait for elective treatment."
