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| NHS waiting times and treatment access are a postcode lottery, report warns | NHS waiting times and treatment access are a postcode lottery, report warns |
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| Wide disparities found in waiting times and referral rates across England for procedures involving medical technology, with south-east faring worst | |
| Nicola Davis | |
| Tue 15 Aug 2017 06.30 BST | |
| Last modified on Wed 20 Sep 2017 23.04 BST | |
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| Waiting times and access to treatments on the NHS involving medical technology are little short of a postcode lottery with dramatic variations across the country, a new report has revealed. | Waiting times and access to treatments on the NHS involving medical technology are little short of a postcode lottery with dramatic variations across the country, a new report has revealed. |
| The study found wide disparities between the performance of NHS England clinical commissioning groups (CCGs) for patient waiting times and referral rates across a host of different treatments, including hip and knee replacements and cataract surgery. | The study found wide disparities between the performance of NHS England clinical commissioning groups (CCGs) for patient waiting times and referral rates across a host of different treatments, including hip and knee replacements and cataract surgery. |
| “Whilst the ambition is to deliver world class healthcare wherever you are, the reality is that many patients in different parts of the country will receive very different treatment,” the report by non profit organisation the Medical Technology Group (MTG) warns. | “Whilst the ambition is to deliver world class healthcare wherever you are, the reality is that many patients in different parts of the country will receive very different treatment,” the report by non profit organisation the Medical Technology Group (MTG) warns. |
| Those in the east and south-east face the poorest service, the report revealed, with CCGs in these regions featuring among the worst performers for both 18-week waiting times between referral and treatment, and the lowest overall rates of procedures carried out. | Those in the east and south-east face the poorest service, the report revealed, with CCGs in these regions featuring among the worst performers for both 18-week waiting times between referral and treatment, and the lowest overall rates of procedures carried out. |
| “The surprise was a clear north-south divide. In 2017 this shouldn’t be happening. Everyone should have equal access to what they need,” said Barbara Harpham, chair of the MTG. | “The surprise was a clear north-south divide. In 2017 this shouldn’t be happening. Everyone should have equal access to what they need,” said Barbara Harpham, chair of the MTG. |
| The issue of waiting times has long been contentious, with NHS England’s chief executive, Simon Stevens, criticised earlier this year by the Royal College of Surgeons of England for relaxing the requirement that 92% of patients are treated within 18 weeks of being referred by their GP. | The issue of waiting times has long been contentious, with NHS England’s chief executive, Simon Stevens, criticised earlier this year by the Royal College of Surgeons of England for relaxing the requirement that 92% of patients are treated within 18 weeks of being referred by their GP. |
| The new report throws the issue into the spotlight, looking at the differences between the 209 CCGs that were operating in England at the start of the year. In particular, the authors focused on waiting times and access to procedures relating to medical technology such as those involving scans, pacemakers, stents and joint replacements. | The new report throws the issue into the spotlight, looking at the differences between the 209 CCGs that were operating in England at the start of the year. In particular, the authors focused on waiting times and access to procedures relating to medical technology such as those involving scans, pacemakers, stents and joint replacements. |
| Based on data from the NHS’s database on 18-week referral to treatment times, the team found that nine of the 10 CCGs with the poorest record were in the south of England (east, south west, London and south east), while six of the 10 best performing CCGs were in the north. Looking specifically at cardiology, CCG performances ranged from achieving the 18-week target 100% of the time to meeting it just 68% of the time. | Based on data from the NHS’s database on 18-week referral to treatment times, the team found that nine of the 10 CCGs with the poorest record were in the south of England (east, south west, London and south east), while six of the 10 best performing CCGs were in the north. Looking specifically at cardiology, CCG performances ranged from achieving the 18-week target 100% of the time to meeting it just 68% of the time. |
| Worst at meeting the 18-week target when all procedures were taken into account was NHS Isle of Wight. | Worst at meeting the 18-week target when all procedures were taken into account was NHS Isle of Wight. |
| The team add that overall, about 90% of 18-week wait targets are now met by the NHS – a drop from the peak of almost 95% in autumn 2012. | The team add that overall, about 90% of 18-week wait targets are now met by the NHS – a drop from the peak of almost 95% in autumn 2012. |
| Looking at rates of referrals for procedures across areas including colonoscopies, cataract surgery and stroke using a further series of NHS datasets, the team found that the poorest performing CCGs overall were largely in London and the south and east, including NHS Camden, Slough, Richmond and Southampton. More specifically, the rate of hip replacements was found to vary from almost 208 per 100,000 people in NHS Kernow to just under 55 per 100,000 in Westminster. | Looking at rates of referrals for procedures across areas including colonoscopies, cataract surgery and stroke using a further series of NHS datasets, the team found that the poorest performing CCGs overall were largely in London and the south and east, including NHS Camden, Slough, Richmond and Southampton. More specifically, the rate of hip replacements was found to vary from almost 208 per 100,000 people in NHS Kernow to just under 55 per 100,000 in Westminster. |
| While the results did not take into account population size or demographics, Harpham said such factors were unlikely to completely account for the disparities. “It doesn’t appear to be just about populations – it appears to be about individual CCGs’ choices of how they spend their money,” she said. | While the results did not take into account population size or demographics, Harpham said such factors were unlikely to completely account for the disparities. “It doesn’t appear to be just about populations – it appears to be about individual CCGs’ choices of how they spend their money,” she said. |
| The latest report is not the first to flag the wide disparities that exist across the country. A recently released report from the health charity the King’s Fund threw up myriad variations in everything from management to outcomes, while a study from the Universities of York and Manchester has highlighted a widening north-south divide in mortality rates among younger adults. Research published last week revealed a growing health gap between the rich and the poor. | The latest report is not the first to flag the wide disparities that exist across the country. A recently released report from the health charity the King’s Fund threw up myriad variations in everything from management to outcomes, while a study from the Universities of York and Manchester has highlighted a widening north-south divide in mortality rates among younger adults. Research published last week revealed a growing health gap between the rich and the poor. |
| The authors of the new report write that austerity measures are leading many CCGs to limit access to treatments. Among their recommendations, the authors argue for a user-friendly website featuring waiting times, with CCGs missing the 18-week target75% of the time in any area forced to publicise the fact on their website. | The authors of the new report write that austerity measures are leading many CCGs to limit access to treatments. Among their recommendations, the authors argue for a user-friendly website featuring waiting times, with CCGs missing the 18-week target75% of the time in any area forced to publicise the fact on their website. |
| Luigi Siciliani, an expert in health economics from the University of York who was not involved in the study, said he was not surprised by the disparities, adding that the decline in waiting times seen since the early 2000s has recently stalled and started to increase. But waiting times cannot be assessed in isolation, he warned. | Luigi Siciliani, an expert in health economics from the University of York who was not involved in the study, said he was not surprised by the disparities, adding that the decline in waiting times seen since the early 2000s has recently stalled and started to increase. But waiting times cannot be assessed in isolation, he warned. |
| “A hospital providing high quality care may have a good reputation and attract more patients, which may translate into a longer wait,” he said. “But some hospitals may have both low quality and long waits, and those should be subject to tighter scrutiny.” | “A hospital providing high quality care may have a good reputation and attract more patients, which may translate into a longer wait,” he said. “But some hospitals may have both low quality and long waits, and those should be subject to tighter scrutiny.” |
| Julie Wood, chief executive of NHS Clinical Commissioners, said waiting times were only one measure of the quality of care and that commissioners were facing increased demand and financial pressures. | Julie Wood, chief executive of NHS Clinical Commissioners, said waiting times were only one measure of the quality of care and that commissioners were facing increased demand and financial pressures. |
| “Commissioners have finite funds allocated to them and the simple truth is that they can only spend their budgets once,” she said. “This means they are having to make increasingly hard decisions to make sure that they provide the patients and the populations they serve with the best possible healthcare within the overall resources they have.” | “Commissioners have finite funds allocated to them and the simple truth is that they can only spend their budgets once,” she said. “This means they are having to make increasingly hard decisions to make sure that they provide the patients and the populations they serve with the best possible healthcare within the overall resources they have.” |
| But an NHS England spokesman pushed back against the report, stressing that over-treatment is as much of an issue as under-treatment. “Although this report by companies seeking to sell products to the NHS is largely a rehash of old and previously published data, the NHS RightCare programme is helping local areas identify which treatment differences are linked to local need, and which aren’t,” he said. | But an NHS England spokesman pushed back against the report, stressing that over-treatment is as much of an issue as under-treatment. “Although this report by companies seeking to sell products to the NHS is largely a rehash of old and previously published data, the NHS RightCare programme is helping local areas identify which treatment differences are linked to local need, and which aren’t,” he said. |
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