Feature

Shorter waits for the clinic?

Patient’s Charter standards have had little effect on outpatient waiting times, says the Radical Statistics Health Group

Statistics on waiting times for first outpatient appointments in England have now been published since September 1994.^{1 2 3 4 5 6} Some have been accompanied by ministerial press releases promising, for example, that ‘the new Patient’s Charter standard on outpatient appointments will provide a major impetus to improving waiting times’.⁷

That standard is that 90 per cent of patients waiting for a first outpatient appointment should be seen within 13 weeks of referral by a GP and all should be seen within 26 weeks. This was not ambitious, given that in the September quarter of 1994, 83 per cent of people were seen before 13 weeks and 96 per cent before 26 weeks.

There were considerable differences between specialties: 89 per cent of patients were seen before 13 weeks in general surgery and 88 per cent in general medicine, compared with 74 per cent in urology and 75 per cent in ophthalmology. This may reflect differences in the proportion of patients admitted by each specialty from waiting lists.

The changes since then can hardly be described as dramatic, as Figure 1 shows. In the December quarter of 1995, 83 per cent were seen before 13 weeks and 97 per cent before 26 weeks. Trends for the most common specialties are shown in Figure 2. Overall, the proportion seen within 13 weeks of referral in the December quarter of 1995 ranged from 90 per cent in general surgery and 89 per cent in general medicine and gynaecology to 70 per cent in trauma and orthopaedics and 73 per cent in plastic surgery.

The total number of patients seen at a first outpatient appointment fluctuated over the six quarters, as Figure 3 shows. Nevertheless, the total for the last two quarters of 1995 was well above that for the corresponding quarters of 1994. But when the totals are subdivided it appears that the total seen after referral by a GP declined, while those seen after referral from ‘other’ sources increased.

These attendances include ‘patients referred by consultants and other health professionals and self-referrals and attendances at “drop in” clinics’. The proportion of people having a first outpatient appointment after referral by a GP fell from 84 per cent of first appointments in the September quarter of 1994 to 74 per cent in the December quarter of 1995. Yet, as Figure 4 shows, there has been no decline in the numbers of referrals by GPs.

What has been happening? It is impossible to draw firm conclusions from these crude data, but it is notable that at the same time the numbers of emergency ambulance journeys were increasing from 2,000,000 in the financial year 1992-93 to 2,270,000 in 1994-95 (Figure 5).⁸

Meanwhile, in Wales there were large falls in outpatient waiting times. Although statistics for Wales are published in a different way, it seems that Welsh patients had longer waits at the start of the period. After the fall, at the end of December 1995, 8 per cent of patients waiting for first outpatient appointments at Welsh hospitals had been waiting more than six months and 32 per cent more than three months.⁸ In Scotland, the median waiting time remained static at 32 weeks over the period from March 1993 to March 1995, and in the year ending March 1995, 5.7 per cent of outpatients waited more than 18 months.⁹