A decade of failure to uphold NHS patients’ rights to timely care

Analysis by the Nuffield Trust reveals that nine of the eleven waiting time targets set out in the health service’s contract with patients [1] are currently not being met. The think tank says the recovery plans set out by campaigning parties in this election are extremely ambitious but currently not based on calculations of whether the NHS can actually deliver enough care to meet them within its budget.  

According to a new briefing, the last time a majority (6 out of the then 10) targets were met was in 2015, and the NHS has never met all eleven at the same time, even counting previous similar targets. The analysis also highlights a systematic inequality where people in poorer areas get worse access to planned care than richer counterparts – for example, the most deprived tenth receive 20% fewer hip replacements than the English average.

The authors say that the relentless focus on unachievable targets without the money, capacity and efficiency to meet them has been a distraction from delivering on policies which could offer meaningful improvements in how quickly people get treated in England, such as building up out of hospital services and sustainable funding for buildings and equipment.

Key findings from the analysis of waiting times, part of an election project funded by the Nuffield Foundation, include: 

• Targets on diagnostic care and A&E waiting times have not been met since 2013 and 2015 respectively. 
• Cancer referral to treatment targets were last met in 2015 and haven't been met since. 
• The target that 92% of treatments should be started within 18 weeks has been missed in every month since February 2016.
• The only targets from the constitution that the NHS meets are mental health talking therapy targets, which have been backed up by large staff and funding increases, and early intervention in psychosis, where the target has been repeatedly delayed or moved downwards.

What health and care need from the next government: Improving access to treatment sets out a series of policy ‘tests’ that must be met to reduce NHS waiting times. It warns the next government against adding new targets when existing ones are being missed, as this risks eroding public trust further and will not create the change patients desperately need.  

In these policy tests, the Nuffield Trust calls on the next government to: only commit to new targets when there is either enough funding or a credible plan for the NHS to be more efficient; prioritise community and mental health services; spend as much on health care buildings and equipment as comparable countries and stop raiding capital budgets; cut down on small, specific, short-term financial pots for improvement; and avoid setting detailed top down targets which don’t account for variation in current services.

Nuffield Trust Head of Public Affairs Mark Dayan said: 

“The British public are seriously dissatisfied with NHS waits, and political parties are clamouring to convince them they have the solutions. But we have seen year after year that ambitious targets and commitments fall flat unless there is enough money, staff, and capacity across the entire health and care system to actually make them happen. 

“We need to learn from the long history of waiting times getting better and worse in the NHS that what works is realistic plans you stick to over time, not lots of panicky short-term pots of money. The next government will need to direct funding away from filling budget holes and into a multi-year campaign to repair buildings, equipment, and out-of-hospital services – as has been accepted for years but never delivered.”