English NHS waiting times: what next?

Harrison, Anthony; Appleby, John

doi:10.1258/jrsm.2009.090044

Cited by 10 publications

(10 citation statements)

References 28 publications

(36 reference statements)

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“…In the United Kingdom, the National Health Service (NHS), as a publicly funded universal healthcare system, has been implementing strategies to cope with the ever-increasing demand for elective treatment procedures in recent years. However, many Trusts in the NHS still have long queues for elective procedures, which have led to much criticism in social and mass media [5][6][7]. Larger queues for elective surgeries with longer wait times had been reported to be a leading source of public dissatisfaction with inpatient services in health and social care in the UK [8].…”

Section: Introductionmentioning

confidence: 99%

Health system performance and health system preparedness for the post-pandemic impact of COVID-19: A review

Rathnayake

2020

International Journal of Healthcare Management

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Newly emerging infectious diseases have had damaging impacts on healthcare systems throughout history and have been most acute in weaker health systems. With the COVID-19 pandemic, even the well-developed health systems are struggling most to cope as the crisis deepens in the regions of Europe and America. This review article attempts to raise concerns for decision makers and health service providers to balance performance amid COVID-19 outbreak with the need to minimize deterioration in the health of people with pre-existing conditions. COVID-19 is now at the forefront of the minds of policy makers, health service providers and the public. All resources are being prioritized to contain the pandemic. Waiting times for elective surgeries have increased dramatically over recent years and it has become a major policy concern in many countries with health systems operated with public funds. The mortality and morbidity caused by COVID-19 may be outnumbered many times if adequate attention is not paid now to the burden of prevailing long waiting queues for the management of non-communicable diseases, cancers and other conditions. Mobilizing researcher support and evidence synthesis of existing research is crucial to health system preparedness for the post-pandemic impact of COVID-19.

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Section: Introductionmentioning

confidence: 99%

Health system performance and health system preparedness for the post-pandemic impact of COVID-19: A review

Rathnayake

2020

International Journal of Healthcare Management

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“…Current NHS targets require 90% of patients to be operated within 18 weeks [11,12]. Accordingly patients were defined as long waiters if the time to surgery exceeded 18 weeks and short waiters, those who waited ≤ 18 weeks.…”

Section: Definitions Of Long and Short Waitersmentioning

confidence: 99%

Non‐randomized studies should be considered for assessing surgical techniques in rectal prolapse: prospective cohort study

et al. 2020

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Aim Randomized trials comparing surgical techniques for rectal prolapse are not always feasible. We assessed whether non-randomized comparisons of those who have had surgery with those still waiting would be confounding baseline health status. Method This was a prospective cohort study in seven UK hospitals. Participants were ≥ 18 years and listed for surgical interventions of equivalent intensity for rectal prolapse. They were defined as short or long waiters (≤ 18 or > 18 weeks, respectively). Time on the waiting list was compared with baseline comorbidity (Charlson comorbidity index) and change from baseline in health status (EQ-5D-5L) at the time of surgery. Results In all, 203 patients were analysed. Median (interquartile range) waiting time was 13.7 weeks (8.1, 20.4) varying across sites. Baseline comorbidity was not an important predictor of waiting time. Median Charlson comorbidity index was 2 (0, 3) for short and 1 (0, 3) for long waiters. A change in waiting time by a week was associated with negligible improvement in the EQ-5D-5L index of 0.001 (95% CI −0.000 to 0.003, P = 0.106). Conclusion Negligible change in patient reported health status while on the waiting list and lack of effect of comorbidities in influencing waiting time support the use of non-randomized pre-/post-studies to compare the effects of surgical interventions for rectal prolapse.

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“…This is particularly relevant for ES treatments, since they are not provided in urgency conditions but are chosen by patients in agreement with their physicians in order to improve their quality of life. In fact, long waiting times for these services can drive patients to opt for private sector services or to renounce to treatment [4–9].…”

Section: Introductionmentioning

confidence: 99%

“…These solutions to reduce waiting times have often entailed strengthening the supply side by increasing the resource availability (operating room hours, personnel and beds), by working on providers’ productivity or by paying extra money to the health professionals to increase production [4, 5]. Nevertheless, these solutions in the long term have failed to radically shorten waiting times at a system level [10, 11].…”

Section: Introductionmentioning

confidence: 99%

Decision making tools for managing waiting times and treatment rates in elective surgery

Lungu

Ruggieri

Nuti

2019

BMC Health Serv Res

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Background Waiting times for elective treatments, including elective surgery, are a source of public concern and therefore are on policy makers’ agenda. The long waiting times have often been tackled through the allocation of additional resources, in an attempt to reduce them, but results are not straightforward. At the same time, researchers have reported wide geographical variations in the provision of elective care not driven by patient needs or preferences but by other factors. The paper analyses the relationship between waiting times and treatment rates for nine high-volume elective surgical procedures in order to support decision making regarding the availability of these services for the citizens. Using the framework already proposed for the diagnostic services, we identify different patterns that can be followed to align the supply with patient needs in the Italian context. Methods After measuring the waiting times and the treatment rates for nine procedures in the 34 districts in Tuscany, we performed correlation analyses. Then, we plotted the results in a matrix cross-checking waiting times and rates. By doing so, we identified four different contexts that require a second step analysis to tackle unwarranted geographical variations and ensure timely care to patients. Finally, for each district and elective surgical procedure, we measured the economic impact of the different treatment rates in order to evaluate whether there are any supply criticalities and eventually some room for maneuver. We also included active and passive mobility of patients. Results The results show a high degree of variation both in treatment rates and waiting times, especially for the orthopaedic procedures: knee replacement, knee arthroscopy and hip replacement. The analysis performed for the nine interventions shows that the 34 districts are in varying positions in the waiting time-treatment rate matrix, suggesting that there is no straightforward relationship between rates and waiting times. Each combination in the matrix may have different determinants that require healthcare managers to adopt diversified strategies. The decision making process needs to be supported by a two-level analysis: the first one to put in place the matrix that cross-checks waiting times and treatment rates, the second one to analyse the characteristics of each quadrant and the improvement actions that can be proposed. Conclusions In Italy, waiting times in elective surgical services are a main policy issue with a relevant geographical variation. Our analysis reveals that this variation is due to multiple elements. In order to avoid simplistic approaches that do not solve the problem but often lead to increased expenditure, policy makers and healthcare managers should follow a two-step strategy firstly identifying the type of context and secondly analysing the impact of elements such as resource productivity, resource availability, pa...

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English NHS waiting times: what next?

Cited by 10 publications

References 28 publications

Health system performance and health system preparedness for the post-pandemic impact of COVID-19: A review

Health system performance and health system preparedness for the post-pandemic impact of COVID-19: A review

Non‐randomized studies should be considered for assessing surgical techniques in rectal prolapse: prospective cohort study

Decision making tools for managing waiting times and treatment rates in elective surgery

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