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NHS operations: Waiting times to rise in ‘trade-off’, boss says

NHS patients in England face longer waits for hospital operations such as knee and hip replacements in a “trade-off” for improved care in other areas, NHS England boss Simon Stevens says. He said he could no longer guarantee treatment in the 18-week target time. And he said GPs would be asked to cut back on the numbers of patients they referred to hospital with other options such as physio encouraged instead. But he said in return there would be quicker cancer diagnosis and A&E care.

◾’Pragmatic strategy’ for NHS England

Mr Stevens was unveiling a progress report on his five-year strategy for the health service, launched in 2014.He said demand was rising at a quicker rate than expected when he originally set out his plans, and so compromises had to be made.”There is a trade-off here – we do expect there will be some marginal lengthening of waiting lists, but this will still represent a strong, quick experience compared to 10 years ago, let alone 20.”

Clare Marx, president of the Royal College of Surgeons in England, said the delays could have more serious consequences. “For hip and knee replacement, it is very painful and very demoralising,” she told BBC Breakfast. “But our concern is not only for hip and knee patients but those patients who perhaps are waiting for heart surgery. “For them, sometimes waiting for surgery may be a part of a pathway where they may have a heart attack whilst they are waiting.”

How long will patients have to wait?

Non-emergency treatments include everything from minor surgery and cataract operations to knee and hip replacements. Patients are meant to be seen within 18 weeks.

There are currently over 360,000 patients on the waiting list who have waited longer than that, which is one in 10 of the total, a proportion that has almost doubled in four years.

Mr Stevens said he expected that to get worse over the next couple of years. But he said it needed to be seen in context of the situation a decade ago, when nearly half of patients were waiting longer than 18 weeks.

Niall Dickson, chief executive of the NHS Confederation, which represents organisations providing NHS care, said the relaxing of the waiting time target was “inevitable” because of a lack of funding. He told the BBC: “Back to the year 2000, people were waiting 18 months or longer and the NHS has delivered 18 weeks as a target.”I think nobody wants to go back to that very, very long time and there will be anxiety about that – but I think it is completely unreasonable to expect NHS services to provide everything, when the restrictions on funding and the demand is rising all the time.”

Mr Stevens said several measures would be taken to reduce the numbers stuck on waiting lists.

GPs are being asked to look at how many patients they are referring to hospital – and whether other options, such as physiotherapy, would be more appropriate than operations.

Mr Stevens said this process could lead to hundreds of thousands fewer patients being referred to hospital.

But Age UK’s Caroline Abrahams criticised the move. “Having to wait a long time for an operation or procedure may not only condemn an older person to misery and pain, it can also undermine their resilience and make it harder for them to sustain their independence. This makes no sense.”

◾10 charts that show why the NHS is in trouble

Curbing drug spending

The NHS spends about £16bn a year on drugs and medicines. But the bill has been rising quickly – up 7% in the past year. This is the largest area of spending after staffing, so NHS England’s report sets out ways this rising cost can be curbed.


Firstly, a cap has been set on the bill for new drugs. The roll-out of any new treatments that are going to cost the NHS more than £20m a year will now be delayed to give health bosses time to open talks with the industry on price.

Secondly, NHS England has said it will review “low value” medicines. These include things such as sun cream, gluten-free foods and some painkillers – a move which could potentially save £400m a year.

Both of these steps had already been announced prior to this report.

◾NHS to introduce £20m cap on new drugs

◾NHS targets suncream prescriptions for cuts

A&E waits to get quicker

In return, NHS England made a series of pledges about how they would improve performance in certain areas.

The four-hour A&E target has been re-committed to.

Hospitals have been asked to start hitting the 95% threshold again by March 2018. Current performance stands at just over 85%.

To help, each hospital is being asked to introduce GP triaging – whereby doctors are placed on the front door to advise patients with minor illnesses and injuries of other places they can get help.

NHS England has promised that half the population will have access to evening and weekend GP opening by March 2018, with the rest of the country following a year later.

More pharmacists and mental health therapists will also be placed in surgeries during normal working hours to provide extra support.

Rapid cancer diagnosis

Breast cancer screening involves mammogram scansImage copyright SPL

Another area that will be prioritised will be cancer care. A strategy was launched in 2015 setting out a vision for “world class” services by 2020.

This latest report sets out how that is beginning to happen, with an upgrade of radiotherapy equipment and the introduction of 10 new rapid diagnostic centres by next March.

The latter will house a range of specialists under one roof, meaning patients will no longer have to be referred back and forth between GP and specialist.

These steps, NHS England said, will help achieve the ambition of ensuring cancer diagnoses are made within four weeks by 2020, and lead to the 62-day target for cancer treatment to once again be hit – it has been missed for much of the past 18 months.

But Mr Stevens admitted the NHS needed more staff in this area to make sure care could continue to improve.

Improving mental health was also mentioned. NHS bosses said access to talking therapies would be improved, while extra beds in mental health units for children and young people would reduce the need for patients to be placed in centres long distances from their families.

But what about the money?

One area Mr Stevens refused to be drawn on was money. When he launched his five-year strategy, he explicitly asked for £8bn of extra funding for the NHS.

Source BBC News