Feature

Things can only get better?

Labour are still insisting they can cut waiting lists — but how likely is it? The Radical Statistics Health Group has the facts

The government’s problems with its manifesto pledge to cut NHS waiting lists by treating an extra 100,000 patients come as no surprise. The promise already looked unrealistic in the summer of 1996 when it was newly spun. Luckily, its lack of precision makes it impossible to monitor. It does not specify any time scale, or the countries of the UK to which it applies.

In England, provisional waiting list figures for 30 September 1997 which prompted Frank Dobson’s announcement of a Waiting List Action Team, showed an overall increase on the previous quarter in the number of people waiting for admission to NHS hospitals for in-patient or day case treatment.¹ Compared with September 1996 there were 146,000 more people waiting overall, with 57,688 waiting over one year — compared with 15,000 a year earlier. The number waiting longer than the Patients’ Charter guarantee time had risen from 25 in September 1996 to 155 in March 1997 and 818 in September.^{2 3}

This rise followed a slight decline in overall numbers and a marked decrease in long waits up to March 1996 (figure 1). The numbers started to rise again in 1996 at a time when many HAs were running out of money and trusts started to close wards temporarily.

As Dobson’s action team will remember, treating patients was not the only method the previous government used to eliminate long waiting times. Figure 2 shows the results of tidying up waiting lists by removing people who no longer required treatment as they had been treated elsewhere or died.⁴

In addition, as Department of Health statisticians remind us: ‘Waiting times begin from the date the clinician decided to admit the patient. Patients subsequently offered a date but unable to attend have their waiting times calculated from the most recent date offered. These are known as self-deferred cases and are included in the total waiting.’¹ The number who ‘self-deferred’ rose over the period September 1988 to September 1995 (figure 3).⁴

In Wales, the total number on waiting lists is also rising (figure 4). The number of Welsh residents waiting over a year rose from 4056 in March 1995 to 5345 in September 1996 and 6810 in September 1997.⁵ Of these, 1600 had been waiting more than 18 months.

In Scotland, data are compiled in a different way, with a ‘true waiting list’ plus separate lists for people who defer for any reason and for people waiting for repeat admissions. Although the number on the ‘true waiting list’ has increased every year since 1991, the number waiting over a year decreased from 11,178 to 643 in March 1996 and 585 in March 1997.^{6 7} Nevertheless, in September 1997 there were still 74 people waiting more than two years.⁷

There is some good news. The government now recognises that there is a problem and has also admitted that length of time waiting should not necessarily be the most important criterion for admission. Frank Dobson has noted that ‘no-one waiting for an operation, no matter how minor, wants to be kept waiting month after month. But surely we can treat first those in most pain and most at risk of complications.’² The question is whether there are sufficient resources to put his good intentions into practice.