The average waiting time for NHS patients is falling significantly – but high-cost ‘spot’ purchasing may be part of the reason. The latest National Statistics figures to then end of April 2008 showed that over the past three years, the average waiting time for an operation has been reduced to four weeks. In April 2005, the figure was over eight weeks.

Halved waiting times
Outpatient appointment waiting times have also fallen over the same period, from 4.4 weeks to 2.2. weeks over the same period. The figures will provide reassurance for ministers and the Department of Health that the NHS is broadly on course to achieve the 18-week maximum referral to treatment (RTT) target by the end of this calendar year.

Just 16 patients were waiting over the 26 weeks standard for inpatient admission at the end of April 2008. The total; on admission waiting lists was 533,200. At the same time, 37,2000 patients were waiting over 13 weeks. This figure was down 1,400 from March 2008, and down 78,000 (67.7%) from April 2007.

Meanwhile, only 59 were waiting over 13 weeks for an outpatient appointment, against a total outpatient waiting list of 781,300. Of these 59, 36 were English residents waiting for appointments in Welsh hospitals. 23,800 awaiting outpatient appointments were waiting over 8 weeks at the end of April 2008: an increase of 1,900 from March 2008, but a fall of 64,200 from April 2007. The numbers on the outpatient waiting list have fallen 40 per cent in the past three years.

The admission waiting list has not been as low as half a million since the 1960s. In 2004, 12-month waits for operations were all but eradicated. In 2006, this also happened to six-month waits. Tony Blair’s former health policy advisor Simon Stevens (now a CEO of US health maintenance organisation United Health) frequently suggested in his presentations on policy that this situation would “represent the end of waiting as we know it in the NHS”.

Important caveats
However, there are reservations on the figures – they do not measure quality of outcome of treatment, and many primary care trusts (local NHS administrative units) now use referral management centres to ‘triage’ admissions

Friday’s figures come with two important qualifiers. They measure how long patients still waiting have waited – not how long patients will have waited by the time they are treated. And many primary care trusts are passing on GPs’ requests for a hospital appointment to “referral management centres”, which may make some actual outpatient waits slightly longer than these figures imply.

Crucially, the Financial Times has reported an un-named senior NHS manager as confirming reports from private sector hospital providers that ther NHS is ‘spot purchasing’ large numbers of operations at the last minute to achieve these rediuctions. ‘Spot purchasing’ is one-off transactions, for which providers charge a premium as they can’t plan for them. The FT quotes this NHS manager saying, “I know of examples where the NHS has recently paid the private sector 140 per cent, and even 160 per cent, of the NHS price to try to hit the waiting time target.”

‘Spot purchasing’ was thought to have largely disappeared due to independent treatment centres (ISTCs) and improved planning of NHS contracts with the private sector”. The Government recently cancelled the majority of the Wave 2 ISTC contracts.