Hospital Dr News

Waiting times grow but no evidence yet that quality of care is deteriorating

Waiting times for many NHS urgent and emergency services in England were at their worst in 2016/17 for the last five years, but there is so far little evidence that the quality of care for some of the big killers – like heart attack, stroke and cancer – is deteriorating.

This is the main message from a pre-election briefing from think tank the Health Foundation, Quality of care in the English NHS: In the balance.

However, the Health Foundation highlights that national data on the quality of care received by NHS patients lags behind information on waiting times and it may be too early to tell whether the pressures on the NHS are affecting the quality of care delivered.

Despite the increase in waiting times, the NHS is treating more patients than ever before. The number of people being treated within waiting times targets has remained relatively stable over the last five years and the difficulty to meet the targets reflects continuing growth in demand and pressure on resources.

Tim Gardner, senior policy fellow at the Health Foundation, said: “More people waited longer to access important areas of NHS care in 2016/17 – for things like admission to hospital from A&E, non-urgent surgery and cancer treatment – than at any time in the last five years.

“However, at the same time, the NHS is treating more people than ever before, including more people within the target waiting times.

“Crucially, for big killers like stroke, heart attack and some cancers, the latest data shows that the quality of care being delivered by the NHS is holding. This may be because it is too early to tell whether the pressures on the NHS are affecting the quality of care delivered. Or it may be a reflection of the incredible hard work of NHS staff to ensure good quality of care is maintained despit tightening resources.”

On access (waiting times) to services, the briefing incorporates recent NHS England data and shows that:

  • A&E: On the target that 95% of patients should be admitted or discharged from hospital within four hours of arriving at A&E, the NHS met this standard 89.1 % of the time in 2016/17, which means that 2.5 million people had to wait longer than four hours to be seen. Importantly, a total of 23.4 million people visited A&E in 2016/17, up from 21.7 million in 2012/13 (when 901,411 were not seen within four hours).
  • Non-urgent treatment: On the target that 92% of people should be treated within 18 weeks of a consultant referral for things like hip and knee replacements, the NHS in England met this standard 90.7% of the time in 2016/17, with 362,687 people on the waiting list at the end of the year having waited more than 18 weeks. This compares to 94.4% in 2012/13, when 153,037 people on the waiting list at the end of the year had waited more than 18 weeks.
  • Cancer treatment: On the target that 85% of patients should wait less than 62 days to start treatment after referral by their GP for suspected cancer, the NHS met this standard for 81.8% of patients, meaning that 26,113 waited longer than 62 days. This compares to 87.1% in 2012/13, when 14,936 people had to wait more than the standard.
  • Ambulance care: On the target that 75% of ambulances reach patients where there is an immediate threat to life within eight minutes, in 2016/17 this was met between 63-69% of the time, meaning that 985,583 people with life threatening conditions waited longer than eight minutes for an emergency response. This compares to 74-76% in 2012/13, when 557,989 people had to wait more than the standard.

Gardner added: “International comparisons show that while there have been internationally recognised improvements in the quality of care for heart attack and stroke – for other illnesses, such as bowel and breast cancer, the NHS is still lagging behind comparable countries on patient outcomes.

“Maintaining, let alone improving, the quality of care provided is going to be very difficult in the current financial climate. Funding for the NHS in England will need to increase if these hard won gains to the quality of patient care are to be upheld and built upon in the future. Waiting time targets for A&E, cancer, and consultant-led treatment are a useful barometer of pressure on the NHS. But these data need to be published alongside more relevant and accessible data on how effective care is for patients.”

On the quality of care received by patients for some significant and prevalent conditions, the Health Foundation’s briefing highlights that:

  • Stroke: The NHS has made substantial improvement in delivering rapid diagnosis and specialist hospital care for people with stroke. For example, in 2016, 47% of stroke services in England, Wales and Northern Ireland were graded as ‘first class’ or ‘good or excellent in many respects’ in the Sentinel Stroke National Audit Programme, compared with 21% in 2014.
  • Heart attack: Around nine in every 10 patients in the UK received ‘gold standard’ hospital treatment for heart attack in 2015, according to the Myocardial Ischaemia National Audit Project, up from only five in 10 a decade before, although progress has levelled off in recent years.
  • Cancers: There have been marked improvements in the quality for care for bowel cancer, with patients able to leave hospital six days earlier after major surgery in 2015 than in 2004. Mortality from breast and bowel cancer – two of the most common forms of cancer in England – has improved over time, although there remains scope for further progress, and at a UK level the NHS is lagging behind some comparable countries on mortality rates from these cancers.
  • Diabetes: More people in England and Wales with diabetes (types 1 and 2) in 2016 received the care recommended by the National Institute for Health and Care Excellence (NICE) to avoid complications than in 2007, although progress has levelled off. A 2014 study ranked the UK fourth best of 30 European countries for quality of diabetes care, behind only Sweden, the Netherlands and Denmark. Diabetes affects around 4.5 million people in the UK, of which over 3 million are in England.
  • Common mental health conditions: Nearly 430,000 people in England completed a course of evidence-based psychological therapies for conditions such as depression in the first nine months of 2016/17, almost double the same period five years ago. Further progress is needed to cut waiting times, and despite improvements mental health services still struggle – particularly for children and young people and people with severe mental illness.

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