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Patient choice damaged by poor waiting list data

Waiting list data needs to be better managed and independently audited, a committee of MPs says.

The Public Accounts Committee report, which examined NHS waiting times for elective care in England, says the hotchpotch of IT and paper-based systems in the NHS make it difficult for trusts to track and collate the information needed to manage and record patients’ waiting times accurately.

Chair of the committee Margaret Hodge MP said the flaws in ‘comparable’ data on hospital performance is undermining patient choice.

NHS patients have the right to receive elective pre-planned consultant-led care within 18 weeks of being referred for treatment.

In 2012-13, there were 19.1 million referrals to hospitals in England, with hospital-related costs of around £16 billion.

The standards introduced by the Department of Health in 2008 are that 90% of patients admitted to hospital, and 95% of other patients, should have started treatment within 18 weeks of being referred.

Since April 2012 there has also been a standard that addresses the perverse incentive for trusts to focus unduly on patients recently added to waiting lists. In April 2013, NHS England introduced zero tolerance of any patient waiting more than 52 weeks.

The PAC report says the DoH cannot be sure that the waiting time data NHS England publishes is accurate.

NHS England publishes waiting time data, based on information provided by trusts, but it has not made sure that this is consistent, complete and accurate.

Trusts are struggling with a hotchpotch of IT and paper based systems that are not easily pulled together, which makes it difficult for them to track and collate the patient information needed to manage and record patients’ waiting time, it says.

The National Audit Office recently found that waiting times for nearly a third of cases it reviewed at seven trusts were not supported by documented evidence, and that a further 26% were simply wrong.

Multiple organisations, including trusts themselves, clinical commissioning groups, Monitor, the NHS Trust Development Authority and NHS England have a quality assurance role. However the external audit provided in the past by the Audit Commission has yet to be replaced and the Department acknowledged the need to do so, with regular spot checks being undertaken to ensure accuracy.

The committee says it is not yet convinced that responsibilities have been clearly defined.

Key recommendations by PAC include:

– The Department must work with NHS England, Monitor and the NHS Trust Development Authority to agree clear actions, responsibilities and a timetable for obtaining assurance that trusts’ systems and processes for monitoring waiting lists produce consistent and reliable data.

– The data should be audited by someone independent of the trust it relates to.

– The current regime of financial penalties for trusts that do not achieve the waiting time standards is not being used to drive improved performance. Commissioners were required to impose fines on trusts for not meeting waiting time standards but, in 2012-13, 80 trusts that had failed to meet at least one of the standards were not fined. Whether or not CCGs apply fines, they should agree clear performance improvement plans with those trusts which fail to meet waiting time standards.

– Too much stands in the way of patients understanding how the waiting list for treatment works. They do not realise that if they cancel or do not attend appointments they may have to wait longer. NHS England must work with CCGs and trusts to make sure that patients are given full information in a clear way about their rights and responsibilities under the NHS Constitution.

– NHS England faces a challenge to gain acceptance for the new e-Referrals system, given the difficulties with Choose and Book. To realise the full benefits of e-Referrals, NHS England must develop clear plans for how it intends to build up confidence in and utilisation of the new system.

Commenting on the report, Dr Mark Porter, chair of BMA Council, said: “Waiting for an operation or treatment can be a worrying and stressful time for patients, so it’s vitally important that information on waiting times is accurate and reliable. It is also essential so that GPs can provide patients with the right information on waiting times, as this can affect where they decide to seek treatment.

“Ministers need to ensure data collection is consistent and reliable. However a rise in the number of private providers and the fragmentation of services, resulting from the government’s top down reorganisation, has made this harder, not easier to achieve.”

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