- The Guardian,
- Friday June 23 2000
Ambitious targets for a drastic shrinking of hospital waiting times have been drawn up by government action teams preparing for the radical review of the NHS to be announced by Tony Blair next month.
Confidential drafts of their recommendations, obtained by the Guardian, set out "milestones towards a vision of five years from now, where 90% of patients wait less than three months for non-urgent hospital care, and no one waits more than six months".
The action team advising Alan Milburn, the health secretary, on improving patients' access to treatment also proposes more that 30 targets for reduced waiting times at every stage of health care.
They include a maximum of:
•Two weeks for suspected cancer patients to get an outpatient appointment;
•Four hours for a patient arriving at an accident and emergency department to be admitted or discharged; and
•One minute for responses to calls to the 999 emergency number or NHS Direct.
The drafts were presented to ministers last week by the six "modernisation action teams" covering reform of the health service in England.
Health department sources said the targets might be amended after computer modelling in Whitehall to assess costs and staffing implications. Ministers know the pace of change will be limited by the time it takes to recruit and train more doctors and nurses. They must also estimate how far cuts in waiting times will stimulate increased demand for treatment. But those in government also know that the NHS review will lack credibility if it does not contain specific and challenging targets.
Final versions of the teams' reports are due in the next two weeks. The national plan for the NHS is to be published towards the end of next month.
The draft modernisation report on speed of access for patients comes from a team that is chaired by Lord Hunt, the health minister, and includes Barry Jackson, the president of the Royal College of Surgeons, and Lord Newton, the former Tory social security secretary. Its analysis of current performance is withering.
"Patients are dissatisfied with the poor accessibility and inconvenience of NHS services. Provision of primary care services outside office hours is still limited, patchy and unrelated to patient needs [with] 20% of people in work put off going to their GP because of inconvenient surgery hours and 29% having to wait two or three days for a GP appointment."
A third of health authorities are reporting serious difficulty in finding dentists for their residents. There are significant pockets of poor GP provision, particularly in deprived areas. Out of hours access to pharmacies is patchy and information can be hard to find.
"During 1998-99, 1.6m patients waited longer than three months for a first outpatient appointment. A further 1.3m waited longer than three months for inpatient admission," the report says.
Average waiting times for knee and hip replacements, coronary artery bypass surgery, cataract extractions and tonsillectomies were well above the 50-day national norm. There were cases where the wait was up to 230 days.
Other problems included a lack of choice for patients about admission times, long waits for patients who were in pain, cancellation of operations on the due day, long waits in accident and emergency departments and patients staying too long in hospital because of lack of support services if they were to leave.
"The standards put forward by the group are ambitious and go way beyond anything that has been achieved by the NHS in the past," the draft says. "But we should be ambitious. With the resources now available we should aspire to, and in time exceed, standards elsewhere in Europe."
To get primary care for people within 24 hours, the team proposes extending the role of community pharmacists to treat symptoms and provide medicines for minor ailments.
There would be more prescribing by nurses. GPs would be expected to spend less time treating minor cases and on non-clinical duties such as signing sick notes.
GPs' surgeries would be expected to open during early mornings, late evenings and at weekends, with single-handed doctors encouraged to work together to extend their access times.
Other proposals include:
•Email advice from consultants as an alternative to hospital referral;
•Authority for nurses and other professionals to refer patients to hospital;
•Flexible hospital working hours, allowing more non-emergency care outside 9am-5pm, Monday to Friday;
•Separation of major and minor cases at accident and emergency departments, with nurses running minor injury clinics; and
•The linking of hospital funding to how well targets are met, and a refusal to authorise health community plans until every organisation involved is using best practice.
The draft report also calls for higher national standards for ambulance response times.
By 2005, it wants 90% of priority emergencies to receive an ambulance within eight minutes. In urban areas it calls for 90% of less urgent cases to be handled within 14 minutes and in rural areas within 19 minutes.
