Researchers have suggested that Hospital Trusts in England are treating patients based on certain targets for the hospital as opposed to their clinical needs. They have warned how the 18-week referral to treatment standard does not give hospitals encouragement to treat patients who have been waiting a short time or those who have passed the threshold.
In 2012, the target introduced was set at 92% to ensure that patients are not waiting any more than 18 weeks from a GP referral to starting treatment for routine, non-urgent conditions.
The University Hospitals Birmingham NHS Foundation Trust and the West Midlands Academic Health Science Network have said it can lead to unintentional consequences.
Researchers have referred to this as the “threshold effect”, meaning there has been an increase in the data, known as discontinuity, and occurs around the target threshold.
Between January 2016 and September 2021, monthly waiting times data was analysed for all 144 non-specialist acute NHS hospital trusts.
Researchers said:
“The figures repeatedly showed a large spike in the number of trusts exactly meeting the 92% target threshold for the 18-week standard, followed by a sharp drop after the target had been reached.”
Therefore, this suggests that some of the trusts were treating the minimum amount of patients waiting less than 18 weeks in order to comply with the standard. They stated:
“The target provides no encouragement to treat patients who have only been waiting for a short time or who have already passed the 18-week wait.
Policymakers should be circumspect in their use of targets. Second, if targets are used, then policymakers should examine for threshold effects routinely. Third, targets should be carefully designed to mitigate threshold effects.”
Recent data shows how the number of NHS Hospital Trusts meeting the target dropped from 92% (2015/16) to 64% (2021/22).
In 2016/17, a financial sanction for missing the targets was removed meaning the percentage of trusts where patients waited less than 18 weeks also decreased.
Nuffield Trust’s Chief Executive, Nigel Edwards, commented:
“Joins a long litany of examples of the unintended impact of targets. The most sustainable approach to meeting a target is to redesign processes and realign resources to ensure that the targets are met a by-product of a well-designed system.”
The NHS argues that suggesting the NHS is incentivising Trusts to not treat those who have surpassed 18 weeks is nonsense and that treatment is based on clinical needs. The NHS has also said that due to the pandemic people can expect long wait times, longer than what it would have been if Covid-19 did not happen.
Comment
It is clear to see that Covid-19 had huge impacts on the NHS hospitals and that there is a serious backlog for them to work through. However, it is not just due to the pandemic that causes backlogs, having limited staff and resources also impacts widely.
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