Treatment waiting times

In 2010, the NHS Constitution was updated to include a patient right, stating that people with a referral from a GP should start their treatment within 18 weeks. This was initially introduced as three national targets in 2008. Since June 2015, the target that at least 92% of people should spend less than 18 weeks waiting for treatment has been the sole measure of waiting time performance.

What's happening to the proportion of people being treated within 18 weeks?

The proportion of people being treated within 18 weeks has been consistently high since the introduction of the various 18 week targets. These targets were that 90% of admitted people and 95% of non-admitted people should be treated within 18 weeks. For 'incomplete pathways', where patients have been referred but treatment has not yet started, the target was 92%. In August 2014, a 'managed breach' of admitted and non-admitted targets was introduced which allowed hospitals to miss these targets without consequence. This managed breach lasted until December 2015 and corresponds to the dip in performance we observe at that time. After this breach it was decided in June 2015 to permanently abolish the admitted and non-admitted targets and that the incomplete target would become the sole measure to monitor treatment waiting times performance.

New operational performance trajectories for NHS providers were introduced in place of the 92% target in July 2016 (Strengthening Financial Performance & Accountability in 2016/17, NHS England).

The 92% incomplete target was breached for the first time in December 2015 with only 91.8% of people spending less than 18 weeks on the waiting list for treatment. As of January 2017 performance had fallen further to 89.9%.

Updated March 2017.

How many people are waiting for treatment?

As those still waiting for treatment (incomplete pathway) has become the sole measure of treatment waiting times it is important to look at the number of people joining the list and waiting for treatment. In mid-2007, the waiting list contained over 4 million people waiting for treatment. This was reduced drastically to fewer than 2.5 million by winter 2009. Since then, we see a clear seasonal trend with the list being bigger over the summer months and shorter in the winter. Beyond these seasonal changes we can also see an overall upwards trend in the number of people on the waiting list. Since April 2015 there have been more than 3 million people waiting for treatment each month. As of January 2017, there were 3.6 million people waiting for treatment.

Updated March 2017.

What's happening to people waiting the longest for treatment (over 52 weeks)?

The proportion of patients with an incomplete pathway waiting over 52 weeks has been falling steadily and has been below 0.3% since November 2011. Although the proportion has fallen, the number of people has increased in the past two years, from 440 in January 2015 to 1,433 in January 2017.

Updated March 2017.

How have referral to treatment times changed in the short term?

The median wait time from referral to treatment (RTT) for all pathways show small fluctuations from month to month. In particular, we see an annual pattern with peaks in the median wait time in December to February each year which are due to people waiting for treatment over the winter. On the graph a line has been added to show the underlying trend. This trend in median wait times from referral to decision to treat for admitted people increased by 1 week between January 2014 and 2017; waits for non-admitted pathways increased by 0.9 weeks, waits for admitted pathways increased by 1 week and incomplete pathway waits also increased by 1 week over the same time period.

Updated March 2017. 

About this data

Once there has been a decision from a consultant that a patient needs treatment, and they have been referred to a hospital, they are on the waiting list and the clock starts on their treatment waiting time. Their treatment pathway, or time on the waiting list, can end in one of two ways:

- 'Admitted': if a patient is admitted to hospital for treatment, the pathway clock stops once they have been admitted either as a day case or inpatient.

- 'Non-admitted': if a patient receives treatment that does not require an admission or is not treated, the clock stops when they receive treatment or when there is a decision that no treatment is needed.

Data for 'incomplete pathways' show patients who have been referred but have not yet started their treatment. These data give an indication of the number of people on the waiting list for treatment each month.

Since October 2015, there is no provision to report pauses or suspensions in RTT waiting time clocks in monthly RTT returns to NHS England under any circumstances.

For further guidance on referral to treatment waiting times, please see the NHS England website

Comments

You should include estimates for RTT non-reporters, especially for the Incomplete Pathways. NHS England now do so in their annual RTT reports. Including such estimates, shows the waiting list at over 3.2M.

George Donald (not verified)
(changed )

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