Can the English NHS meet the 18-week waiting list target?

Abstract

Waiting lists for hospital treatment are often viewed as a peculiarly British disease. While it is erroneous to think that other developed countries do not suffer waiting lists,1 there is little doubt that long waits for hospital treatment have dogged the National Health Service for many years and are a source of dissatisfaction among patients. Waiting lists for treatment have grown steadily since the inception of the NHS. Only since 1999 has there been a sustained decline in the numbers of people waiting. Waiting times for treatment, perhaps a better measure of system performance, have waxed and waned over the last decade as various initiatives by governments of all political hues have sought to tackle the problem of service access. Successive governments have tended to focus on reducing the maximum waiting times for outpatient appointments and inpatient treatments. The current Labour government has now raised the stakes further. It has pledged that by 2008 there will be a maximum wait of only 18 weeks from any referral of a patient by a general practitioner to treatment in hospital if required. Such a target represents a large step up in expected performance. Current targets are that by the end of this year, no patient will wait more than 3 months for an outpatient appointment and a further 3 months for any inpatient or day-case treatment. Meeting the new target will require a massive effort, and despite considerable success to date, could it be a target too far? And, moreover, is there now a case for a change in focus on waiting times to address broader issues such as equity of access?