NHS waiting times: Fiddlers on the loose

Nine years ago I audited the records of my diabetic patients whom I had referred to see a hospital consultant. I was shocked to find that half of them had not been seen – and these were elderly, housebound, highly vulnerable patients over whom I had concerns ranging from  sight loss and nasty ulcers to suspected mini-stroke (TIA).

So the fact that the majority of patients are now seen and treated within 18 weeks is a huge improvement. Yet the NAO report on inaccurate reporting of waiting times casts a shadow on the reliability of the figures, leaves patients doubting the validity of published data on which they have partly based their treatment decision and compounds doctors frustration over their loss of discretion to who to treat first.

This is an independent audit and whilst some errors can be genuine, that can’t account for the 25% of data found to be falsely recorded. In the old days, this is the kind of fiddling that the local Community Health Council would have uncovered. Sadly they now take the emasculated form of Healthwatch, bodies which are under funded and left to react to news stories rather than undertake any proactive monitoring and scrutiny. The Department of Health refute the NAO’s numbers, but the NAO is an independent body reporting the facts as they find them. It might be politically inconvenient but it’s also a politically driven target. Waiting lists had already fallen significantly in the early naughties as independent sector treatment centres (ISTCs) were commissioned to undertake more procedures and bring down the long delays experienced by patients between referral and operation. 18 weeks was brought in as the target referral to treatment time in 2008, along with 100 pages of guidance. It was one of the targets retained by the coalition government.

So, what to do? Well yet again this is another reason we should all have integrated, personal electronic health record (PHR). Not only could a referral date not be disputed, but the patient would know exactly what was going on, all correspondence would be visible and obtainable, and manipulation would be prevented or visible by the electronic audit trail. NHS Choices says that if you wait for longer than you should, the ‘NHS’ should do something about it. It would help having the proof at your finger tips, but really, if there isn’t a named patient advocate, then is anything really going to change? And the patient reviews on the site don’t include anything about waiting times, so if we are relying on the hospital’s own reporting system, why would they want to jeopardise the CEO’s job with revelations about missed targets?

I think we all understand the value of targets. I know they are a useful measure for politicians and the public alike, but they also produce some perverse behaviours. Anything that needs 100 pages of guidance is not fit for purpose – and the manipulation of figures revealed today indicates an intelligent review is urgently required.




About Julia Manning

Julia Manning is a social entrepreneur, writer, campaigner and commentator. She is based in London and is the founder and Chief Executive of 2020health, an independent, social enterprise Think Tank whose aim is to Make Health Personal. Through networking, technology, research, relationships and campaigning 2020health has influenced opinion and action in fields as diverse as bioethics, alcohol, emerging technologies, fraud, education, consumer technology and vaccination. Julia studied visual science at City University and became a member of the College of Optometrists in 1991. Her career has included being a visiting lecturer at City University, a visiting clinician at the Royal Free Hospital, working with south London Primary Care Trusts and as a Director of the UK Institute of Optometry. She specialised in diabetes (University of Warwick Certificate in Diabetic Care) and founded Julia Manning Eyecare in 2004, a home and prison visiting practice for people with mental and physical disabilities using the latest digital technology, which she sold to Healthcall (now part of Specsavers) in 2009. Experiences of working in the NHS, contributing to policy development, raising two children in the inner-city and standing in the General Election in Bristol in 2005 led to Julia forming 2020health at the end of 2006. Julia is a regular guest on TV and radio shows such as BBC News, ITV’s Daybreak/ GMB, Channel 5 News, BBC 1′s The Big Questions, BBC Radio, LBC and has taken part in debates and contributed to BBC’s Newsnight, Panorama, You and Yours and ITV’s The Week. She is mum to a rugby-mad son, a daughter passionate about Shakespeare, and wife of a comprehensive school assistant head-teacher. She loves gardening, ballet, Zimbabwe, her Westies Skye and Angus, is an honorary research associate at UCL and a Fellow of the RSA.
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