Poor waiting time performance risks increased negligence claims

DECLINING waiting time performance in England for both elective and cancer treatment could lead to increasing future negligence claims, the National Audit Office (NAO) has warned.

A new NAO report states that the elective care standard for 92 per cent of patients to be seen by a consultant within 18 weeks after referral was last met nationally in February 2016 and in November 2018 had fallen to 87.3 per cent.

The elective care waiting list grew from 2.7 million to 4.2 million between March 2013 and November 2018, while the number of patients waiting more than 18 weeks grew from 153,000 to 528,000. During this period, the number of people treated each month increased from 1.2 million to 1.3 million.

The key standard for cancer care of 85 per cent of patients being treated within 62 days of an urgent GP referral for suspected cancer has not been met since the end of 2013. In November 2018, only 38 per cent of NHS trusts met this standard, and between July and September 2018, 78.6 per cent of patients were treated within this timescale.

Waiting time performance was found to differ significantly across England, with the number of patients waiting less than 18 weeks for their elective care varying between 75 per cent and 96 per cent across clinical commissioning groups (CCGs). The percentage of cancer patients treated within 62 days following a GP referral also differed across CCGs from 59 per cent to 93 per cent.

Elective care waiting time standards are being met for some specialties, such as general medicine, but not others, such as surgical specialties. For cancer, performance for lung, lower gastrointestinal, and urological cancers was significantly lower than with other cancers. But increases in the number of urgent referrals have improved early diagnosis of cancer. The proportion of all cancer patients diagnosed through urgent referrals increased from 31 per cent in 2010 to 38 per cent in 2016.

The NAO report links constraints on capacity, including lack of finance, staff and beds with the decline in waiting time performance. It identified persistent staff shortages in diagnostic services and a widening gap between demand for these services and the number of staff working in these areas.

The report states that almost 40 per cent of clinical negligence claims are brought because of delays in diagnosis or treatment and this means there is a risk that longer waiting times may lead to increasing future claims.

Amyas Morse, the head of the NAO, said: "The NHS’s actions to increase the number of urgent cancer referrals are a positive step. They have helped to diagnose more patients at earlier stages, leading to better outcomes, even though this has meant that waiting times commitments for cancer care are no longer being met.

"However, there has been insufficient progress on tackling or understanding the reasons behind the increasing number of patients now waiting longer for non-urgent care. With rising demand for care as well as constraints in capacity, it is hard to see how the NHS will be able to turn around this position without significant investment in additional staffing and infrastructure."