BMJ Investigation: Half of England's ICBs Impose Minimum Waits of Up to 16 Weeks for Elective Surgery
核心洞察
Exclusive BMJ data show 17 of 36 Integrated Care Boards (搜索) in England have imposed minimum waits of 12 to 16 weeks for procedures including hip, knee and cataract (搜索) surgery.
Two ICBs, Shropshire, Telford and Wrekin and West Yorkshire, set 16-week minimum waits for all routine procedures, risking the NHS Constitution's 18-week standard.
The Royal College of Surgeons said it is concerned by the scale of measures that prolong patients' pain, while the RCGP called the waits difficult to justify.
Nearly half of England's Integrated Care Boards (搜索) (ICBs) are deliberately delaying patient care by imposing minimum waiting times in an attempt to manage demand and control costs, according to exclusive data published by The BMJ.
The BMJ sent Freedom of Information requests to all 36 ICBs in England, which are responsible for planning health services for their local populations. Thirty-five boards responded, a 97% response rate. Of these, 17 (49%) confirmed they had imposed some form of minimum wait, with waits ranging from 12 to 16 weeks for procedures including hip, knee and cataract (搜索) surgery. A further 17 ICBs said they did not have a minimum wait, while one — NHS North East London — was unable to say.
Blanket 16-Week Waits and the 18-Week Standard
Among the ICBs with minimum waiting times in place, two — Shropshire, Telford and Wrekin and West Yorkshire — have introduced a minimum wait of 16 weeks for all routine procedures. Experts warn that imposing blanket 16-week waits in particular risks breaching the NHS Constitution's 18-week referral-to-treatment standard, a target that has not been hit nationally since February 2016.
The FOI responses show that South East London has introduced a 16-week minimum wait for cataract (搜索) treatment, while Humber and North Yorkshire has imposed a "planning assumption" of 16 weeks, under which NHS and independent providers expect patients to wait an average of 16 weeks. North East and North Cumbria has imposed a similar planning assumption that patients will wait an average of 15 weeks for all elective procedures.
Six other ICBs — Birmingham and Solihull, Black Country, Coventry and Warwickshire, Devon, Hereford and Worcestershire, and Somerset — have a minimum wait of 14 weeks for all elective procedures. Leicester, Leicestershire and Rutland has a 14-week minimum wait for orthopaedics and ophthalmology, Thames Valley has a 14-week minimum wait for cataracts, and Dorset has a 14-week minimum wait for independent surgical providers of NHS care.
Clinical Colleges Challenge the Rationale
Reacting to the data, Royal College of Surgeons of England president Tim Lane said: "We recognise the significant financial and capacity pressures facing the NHS, but minimum waits risk meaning that patients who are clinically ready for treatment are deliberately made to wait."
He added: "For patients, this can mean living with pain, living with reduced mobility, experiencing anxiety for longer, as well as being unable to work or carry out normal activities. There is also a risk that a patient's condition may deteriorate while they are waiting, potentially changing their clinical needs and priority for treatment."
Royal College of General Practitioners (搜索) president Victoria Tzortziou Brown said blanket minimum waiting times "are difficult to justify, particularly where patients could otherwise be treated sooner." She added: "At a time when the NHS is trying to bring waiting times down, we should be doing everything possible to ensure patients can get the care they need without unnecessary delays."
Equity Arguments and Unresolved Questions
Sally Gainsbury, senior policy analyst at the Nuffield Trust (搜索) think-tank, told The BMJ that limiting activity by a certain minimum waiting time "can be an equitable and rational response to making sure your budget is spread evenly across your population," but added: "I'm concerned there isn't clarity on how to do this fairly."
Some ICBs told The BMJ the measures allowed them to make the best use of financial resources and ensure patients were treated fairly. An NHS spokesperson said: "While commissioned wait policies help the NHS make the best possible use of its services, staff and budgets — all patients are seen in order of clinical need."
The spokesperson added: "We recognise that any wait for treatment can be difficult for patients, and we would not expect any organisation to commission waits that risks breaching NHS Constitution standards, which set an 18-week maximum wait for elective treatment."