Headlines: January 11th, 2006

The National Health Service is likely to meet the Government’s 18-week waiting list target according to an article today in the “Journal of the Royal Society of Medicine” – but the authors question whether the target is in the interest of patients.The article, written by Richard Lewis and John Appleby, the King’s Fund Senior Fellow in Health Policy and Chief Economist, examines the Government’s pledge that by 2008 there will be a maximum wait of 18 weeks following any patients referral by a GP to treatment in hospital if required. They argue that this will be achieved but raise doubts over whether in the long run it is in the interest of patients and the system to meet the target

They write, “Despite the forgoing pessimism about the impact of choice and payment by results on waiting times, there are grounds to think that the NHS will substantially hit the 18-week target,” but they continue, “Perhaps the more fundamental question to ask is should the 18-week target be met? And, in particular, is the cost of achieving it worth the benefits?”

They point to research on patient preferences which shows that although waiting times were an important factor for patients when they chose a hospital, many of them were willing to forego faster access to treatment in favour of longer waits at ‘reputable’ hospitals. The article says that As the Health Service progresses towards the target fundamental questions of access, of which waiting times are only a part, are raised.

Access to healthcare and use of it is not, they say, equitably distributed geographically or across population groups or according to need. Tackling that aspect of access is difficult but it goes to the heart of the reason for the existence of the NHS.

The paper also argues that the cost of meeting the 18-week target may be disproportionate to the benefits it brings. “As waiting times reduce, the value patients place upon further reductions starts to diminish,” say the authors. They suggest a better strategy would be to set differential targets for diagnosis and treatment so that in the future shorter waits are mandated for urgent compared to elective care. In the meantime, they argue, it would be valuable to have a wider debate on what length of waiting time for non-urgent care would be reasonable.