Patients risk being in ‘unnecessary pain’ over NHS minimum waits for treatment

Patients risk being left in “unnecessary pain” as NHS chiefs force hospitals to introduce minimum waiting times for treatment, health experts have warned.

Some local NHS organisations have introduced minimum waiting times as part of their drive to control costs and set priorities, telling hospitals they will will only pay if patients have waited three months or more for things such as hip replacements.

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As first reported in The Times, the policies include blanket minimum waiting times of 12-16 weeks in some regions.

In Devon, a 14-week wait has been applied to “clinically routine cases” while in Shropshire, a minimum wait of 16-18 weeks applies “unless there is verifiable clinical urgency”, the Times reported.

In South Yorkshire, as a result of “significant financial challenge” the region is “requiring providers to slow down the rate of delivery to a minimum of 13 weeks”, documents suggest.

In north-east London, bosses say an interim goal of treating 65% of patients within 18 weeks will be a maximum, citing a reduction in the money available for routine treatment.

Other regions vary more by type of treatment, with some putting blocks in place for cataracts or inpatient ear, nose and throat cases.

Earlier this year, NHS England published guidance with detail on minimum waits, saying hospital trusts and local commissioners must agree plans on the expected “volume of activity” across the year.

It said commissioners may wish to set “activity planning assumptions”, which can include introducing minimum waiting times.

In April, NHS England chief executive Sir Jim Mackey told a Health Service Journal (HSJ) summit that the new rules would give commissioners “the ability to say to providers…‘You might be able to do a cataract in four days, but I want you to do it in 10 weeks, because that’s what we’ve decided is necessary’.”

He suggested this may help support other priorities, for example big cancer or mental health waiting times.

However, experts said the move risked leaving people in pain or facing unnecessary delays.

Tim Mitchell, president of the Royal College of Surgeons of England, said: “Used in this way, minimum waiting times risk distorting clinical priorities and leaving patients in unnecessary pain and anxiety.

“Treatment should be delivered as promptly as possible, based on clinical need.

“We recognise the financial pressures facing the NHS but delaying treatment to balance the books is not the answer.

“Instead, we need targeted investment to expand surgical capacity and upgrade the ageing NHS buildings and infrastructure that continue to hold back efforts to meet the 18-week waiting time target.”

An NHS spokesman said: “We have asked all parts of the NHS to bring waiting times down while we continue to prioritise the most clinically urgent patients.

“There is no policy supporting minimum waits in the NHS and we will work closely with all systems to ensure they deliver the expected level of improvement in waiting times set out in our 25/26 planning guidance.”

NHS Integrated Care Boards (ICBs) have been contacted for comment.

Nuffield Trust senior policy analyst Sally Gainsbury said: “This highlights the stark reality of a health service facing higher patient demand than it can meet within its budget and available capacity.

“The NHS has a responsibility to use its resources fairly and although patients will find minimum waiting times distressing, they can represent an attempt by the NHS to ensure patients with particular conditions, such as cataracts, do not in effect receive care at the expense of others.

“There are millions of people waiting for planned treatment, and the Government has made waiting times a key target for the next election.

“But this is not the only form of care the NHS provides. NHS organisations do need to strike a balance with those patients needing emergency care, primary care or mental health care, too. Balancing those competing demands is really difficult to do.

“With so much pressure on resources, there is a need for a shared understanding between the public and the NHS about how different treatments should be prioritised in a way people can agree is fair.

“Unfortunately, politicians are often reluctant to accept this need for honesty, and there is a real risk that the emphasis on the patient as a consumer of healthcare expected in the 10-year plan will exacerbate pressures.”

A spokeswoman for NHS South Yorkshire said there had been clinical input into the decision, adding: “We are committed to making care better, faster and more efficient, as well as prioritising more urgent treatment such as for cancer.

“To make waiting times equitable across our region we have asked providers to work to a minimum wait of 13 weeks for routine care. This is within the 18-week constitutional standard.”