NHS ‘deliberately delaying patient care’ in England, investigation finds

Almost half of England’s health boards are deliberately delaying treatment for some patients by imposing minimum waiting times in an effort to manage demand and control costs, an investigation has found.

Analysis published by The BMJ found that 17 of England’s 36 Integrated Care Boards (ICBs) have introduced minimum waits of between 12 and 16 weeks for some planned treatments, including hip, knee and cataract surgery.

The findings have prompted concern from medical leaders, who warned patients who are clinically ready for treatment could be left living with pain and reduced mobility for longer than necessary.

The BMJ used Freedom of Information requests to obtain information from England’s ICBs, which are responsible for planning healthcare services for their local populations.

Of the 35 boards that responded, 17 confirmed they had some form of minimum waiting period in place, while another 17 said they did not. NHS North East London was unable to confirm whether it had one.

Some of the longest minimum waits identified were in Shropshire, Telford and Wrekin and West Yorkshire, where 16-week minimum waits have been introduced for routine procedures.

West Yorkshire said it had a target for 90% of patients to wait at least 16 weeks for treatment, although clinicians could prioritise patients at risk of deterioration.

South East London has introduced a 16-week minimum wait for cataract treatment, while Humber and North Yorkshire uses a planning assumption under which NHS and independent providers expect an average 16-week wait for routine planned procedures.

Elsewhere, North East and North Cumbria has a 15-week planning assumption for elective procedures.

Birmingham and Solihull, Black Country, Coventry and Warwickshire, Devon, Hereford and Worcestershire and Somerset were among ICBs identified as having 14-week minimum waits for elective procedures.

The findings have raised concerns because NHS patients have a right under the NHS Constitution to start non-urgent consultant-led treatment within a maximum of 18 weeks in most circumstances.

Tim Lane, president of the Royal College of Surgeons of England, said the organisation was concerned about the scale of the measures.

He said patients who were clinically ready for treatment should not be deliberately made to wait, warning that unnecessary delays could prolong pain, restrict mobility, increase anxiety and allow health conditions to deteriorate.

He added that access to treatment should be determined by clinical need rather than where someone lives and warned widespread minimum waits risked creating a postcode lottery.

Professor Victoria Tzortziou Brown, president of the Royal College of GPs, said longer hospital waits could also increase pressure on general practice as patients returned to their GP for support while awaiting treatment.

She said blanket minimum waiting periods imposed for administrative or financial reasons were “difficult to justify” when patients could otherwise receive treatment sooner.

However, Sally Gainsbury, senior policy analyst at the Nuffield Trust, said limiting activity through minimum waiting periods could be a rational way of ensuring healthcare budgets were spread evenly across a population, although she raised concerns about whether there was sufficient clarity around how this could be done fairly.

An NHS spokesperson said commissioned waiting policies helped the health service make the best use of its services, staff and budgets, but stressed patients were seen according to clinical need.

The spokesperson added that the NHS would not expect organisations to commission waits that risked breaching NHS Constitution standards, which set a maximum 18-week wait for elective treatment.

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