Recent NHS reforms, such as the introduction of patient choice and provider competition, have not had a harmful impact on equity with respect to waiting times for elective surgery in England, a new study concludes.

Until recently, hospital waiting times were seen as a significant problem for the NHS, but over the past 10 years they have dropped considerably, say the researchers, led by health economist Zack Cooper and Professor Julian Le Grand, both of the London School of Economics (LSE). During this time, the government increased the supply of doctors, raised levels of funding for the health service, set rigid waiting time targets and, more recently, introduced market-based reforms, but little has been known about whether the drop in waiting times had been equitably distributed with respect to socioeconomic status.

For their study, the researchers examined changes in waiting times for patients undergoing three key elective procedures - hip replacement, knee replacement and cataract repair - in England between 1997 and 2007.
Their findings, published on bmj.com on September 4, indicate that while average waiting times showed an initial increase, they then fell steadily over time and that, by 2007, there was far less variation in waiting times across the population. _In 1997, patients from more deprived areas waited longer for treatment than those from more affluent areas, but by 2007 this phenomenon had disappeared - in fact, in some cases, patients from more deprived areas were waiting less time than patients from more affluent areas, they say.
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While many had feared that the government’s NHS reforms would lead to inequity or injustice, the study's findings show that inequity with respect to waiting times has not increased - indeed, if anything, it has substantially decreased, the authors comment. __They acknowledge that their findings cannot prove which particular policy mechanisms led to the reductions in waiting times and improvements in equity, but emphasise that the results do confirm that these reforms did not lead to the inequitable distribution of waiting times across socioeconomic groups that many had predicted.__

Commenting on their findings in The Guardian newspaper, the authors point out that, while some would argue that the declines in waiting times were driven by increased spending, rather than targets, patient choice and hospital competition, money alone cannot explain why waiting times have dropped and equity has improved in England. “During the same period that we examined waiting times in England in our study, Scotland and Wales, which both explicitly rejected market-driven reforms, have spent more per patient but have seen much smaller decreases in waiting times,” they write, adding: “our results suggest that it is possible to create incentives for healthcare to become simultaneously more efficient and more equitable.”

“As the government continues to emphasise the importance of choice and competition, these findings should be incorporated into the discussion of whether these reforms will necessarily lead to greater equity or inequity,” they write on bmj.com. __