The government's much-publicised drive to cut referral to treatment times to under 18 weeks by the end of the year has no chance of succeeding, claims a report by independent social-policy think-tank Civitas.

According to the report Why are we waiting, meeting the target of treating 85% of patients within 18 weeks by the end of March is in jeopardy because of the “lacklustre performance of some strategic health authorities, primary care trusts and hospital trusts”, and it predicts that, by the end of the year, around 77% of patients will be turned around within the allocated timeframe.

Going back to the root of the problem, the report’s author James Gubb, Director of the Civitas Health Unit, says Labour’s attempts to tackle the bulging NHS waiting lists it was left with were centred on moving away from a culture of waiting to one of booking. Consequently, it set in place new targets on all service levels - including a maximum 48-hour wait to see a GP and four hours in accident and emergency before hospital admission - to address the waiting-list problem.

Unfortunately, although the majority of these targets were met and significantly slashed waiting lists, the achievement seems to have come at some cost. According to Gubbs, there is strong evidence of ‘gaming’ of the system, whereby healthcare professionals are “doing what is necessary to meet the target, without necessarily doing what is best for the patient”. This is clearly illustrated by the practice of keeping patients in ambulances until the A&E departments are ready to deal with them, he says.

Choice and competition
The report claims the long-term solution for faster access to care is not targets, but choice and competition, and that the unwillingness of GPs to provide the relevant information to patients, “out of a misplaced desire to protect the inefficient local healthcare system”, is proving to be a major stumbling block.

The fact that, from April this year, patients will be able to choose where to receive elective treatment from all Department of Health-approved providers anywhere in the country should help to drive service provision, and it points out that patients willing to travel should get quicker treatment. “If this means more patients choosing to have their treatment in the independent sector, then the sector should be allowed to expand in response to this”, it says.

“It must now be down to PCTs and GPs to encourage choice and competition to ensure the window of opportunity that has been provided isn't missed. For the benefits of competition to be realised, and for waiting times to really accelerate downwards, the reluctance of commissioners to use independent providers at the expense of established NHS providers has to change - and fast”, Gubbs stressed.