25 August 2017
Robert Reed

Robert Reed

Research Analyst
QualityWatch

The NHS sets a range of standards which patients can expect in relation to waits for ambulance services, A&E, diagnostic tests and treatment. We’ve added the latest data to our interactive indicators. (We also publish ‘latest data’ posts the morning these data are released each month - see here for these.) Here we look at some of the key trends in the data.

Accident & Emergency

The maximum four-hour wait in A&E is a requirement for all NHS hospitals. The proportion of people seen in less than 4 hours has been declining in recent years. As of Q4 2016/17, performance against the 95% target fell to 81%, the worst level since the introduction of the target.

For an in-depth analysis of what's causing increasing A&E waits, see the QualityWatch report Focus on: A&E attendances.

Waiting times for referral, diagnosis and transfers

Swift referral and prompt diagnosis are key determinants of care quality. Shorter waits allow patients quicker access to the treatments they need. The NHS constitution stipulates that patients with a referral from a GP should start their treatment within 18 weeks. As of June 2015, the target was that at least 92% of patients should spend less than 18 weeks waiting for treatment. From 2012/13, the target for diagnostic waits was that no more than 1% of patients should wait six weeks or longer for a diagnostic test.

The latest data show an increasing trend in patients waiting longer for referral to treatment. For example, median wait times from referral to decision to treat for patients on incomplete pathways (waiting to start treatment) increased by around 1 week between 2014 and 2017. The proportion of people receiving diagnostic tests within 6 and 13 weeks has remained relatively steady. Since early 2008, the proportion of patients waiting between 6 and 13 weeks for a diagnostic test has consistently been below 5%, though is still below target.

Timely transfer to other areas of care is another essential part of the treatment process. The current high rates of bed occupancy, as well as social care cuts, put extra pressure upon the NHS. Delayed transfers of care (DTOCs) have risen recently. One explanation for this is the increasing number of patients that are ready to leave hospital but are unable due to lack of support or availability of social care. See the Nuffield Trust’s latest briefing on DTOCs for further analysis.

Cancer referral and treatment waiting times

The National Institute for Health and Care Excellence (NICE) has produced referral guidelines for suspected cancer. The first being that a patient shouldn't have to wait more than two weeks to see a specialist if your GP suspects you have cancer and urgently refers you. The second is that in cases where cancer has been confirmed, patients shouldn't have to wait more than 31 days from the decision to treat to the start of treatment.

The NHS Cancer Plan introduced in 2000 stated that there should be a maximum two-week wait for a first outpatient appointment for patients referred urgently by a GP with suspected cancer. This indicator looks at the percentage of people who were seen within two weeks of being referred. The percentage of patients with an urgent referral from GP having their first consultant appointment within 2 weeks was 95% in Q4 2016/17.

Cancelled operations

Cancelled operations lead to increased costs and workloads, and decreased efficiency. There is also a huge impact upon patients and their families. Data regarding cancelled operations can offer important insight into hospital capacity as cancellations are often due to insufficient facilities, equipment or personnel. The latest data shows that the number of cancelled elective operations peaks each year around October, November and December. This is likely due to hospitals dealing with winter pressures.

Between Q4 1994/95 and Q4 2016/17 there was a 47% (6,753 cancellations) increase in the number of cancelled elective operations. Despite this increase, the proportion of elective admissions cancelled declined slightly and stood at 1% (21,219) in Q4 2016/17.

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