A delay to a patient’s treatment can be due to various reasons, some are obvious, such as too few staff leading to a long wait in A&E or lack of equipment resulting in a delay to carry out a procedure or treatment.
However, delays in treatment can also be caused by a patient being directed elsewhere in the system as organisations may not have the necessary funding. The patient could be sent to another NHS organisation, such as from a GP practice to a hospital. In addition, the patient could be sent to a local authority payer or even left to pay for their own care. There is considerable evidence that delays to treatment are increasing in all areas of the NHS.
International comparisons show that the UK has less beds and doctors per head of population than other countries and this is likely to be a contributory factor to delays to treatment. The latest data from 2013 shows that the UK had 2.8 doctors per 1,000 people, compared to 4.1 in Germany, 3.9 in Italy, 3.8 in Spain, 3.4 in Australia, and 3.3 in France. In terms of beds the UK had 2.8 hospital beds per 1,000 people, compared to 8.3 in Germany, 6.3 in France, 3.1 in Denmark, and 3.0 in Spain.
Worst performance since records began
The NHS has national minimum waiting time targets for numerous situations, including A&E, elective surgery and cancer diagnosis and treatment. This makes it relatively easy to track how the NHS is performing in these areas. The statistic that always makes the headlines is the wait in A&E: there is a national target that 95% of people should wait less than four hours in A&E. The performance data for January and February 2016 were the worst since the records began, with only 83% of patients who attended A&E being seen within four hours in January and 81.6% in February, way below 95%. Even in April 2016, when the winter was long over, only 90% of A&E patients were seen within four hours.
Delays to treatment were not confined to A&E – the largest number of people since records began had to wait more than the maximum of 18 weeks for planned care in hospital and the NHS also missed its targets in many other areas, including cancer referral times. In March 2016, the HSJ reported that the true figure for the number of patients waiting 52 weeks or more for planned treatment is actually much higher than the official NHS England data: at least 378 more patients have been waiting a year or more. However, this figure could be still higher as the figures do not include nine hospital trusts that are allowed to not report this data.
Long delays in mental health services
Although the Government does not collect data on waiting times in many other areas, surveys and anecdotal evidence have shown that waiting times are increasing. In mental health services waiting times for treatment are a serious problem. Figures from 2013-14 show that the average waiting time for a child seeking a routine appointment with a mental health practitioner was 21 weeks, up from 15 weeks the year before and the average maximum wait for a community mental health team appointment was 30 weeks. In September 2014, a coalition of charities called We Need to Talk reported a survey of 2,000 people who tried to access talking therapies, including non-IAPT. The survey found that half of the people waited more than three months and one in 10 waited more than a year for an assessment. Whilst waiting, 67% became more mentally unwell, 40% harmed themselves and one in six attempted to take their own life. In September 2015 a survey of more than 1,000 GPs found that 66% see waiting times for psychological therapy as the biggest barrier to treatment.
More recently, in February 2016, a report leaked to The Observer, based on a study, overseen by Paul Farmer, chief executive of the mental health charity Mind, highlighted the dire situation England’s mental health services are in, with suicides increasing and three quarters of people with psychiatric conditions not receiving help. A personal story of trying to access help for mental health conditions, reported in The Guardian, told of an initial three month wait and then never being able to get hold of the person to make an appointment leading to a wait of six months overall. In April 2016 a report from the CentreForum noted that mental healthcare providers refuse to treat an average of 23% of the under-18s referred to them by concerned parents, GPs, teachers and others. The analysis also reveals that the longest waiting times experienced by users of child and adolescent mental health services (CAMHS) have doubled in the last two years, with waiting times of up to two and a half years reported.
More recent reports have found that as the criteria are tightened for referrals for children and young people with mental health conditions to specialist services, it is harder and harder for patients to actually get put on the waiting list, with many referrals just batted back to GPs. In a Pulse investigation reported in July 2016, the numbers of referrals that progress to treatment decreased from 44% in 2013 to 39% in 2015. Many GPs report that CAMHS refuse to treat patients unless they had attempted suicide or self-harmed. GPs are told to contact local charities or send the child to a school counsellor.
Delays at the GP
It is much harder to find figures on how access to GP services has led to treatment delays. The most obvious situation is the difficulties of getting a GP appointment. As there is no central data collection the only information on how easy the public are finding it to access their GP comes from the national GP patient survey. In July 2015, 11% of adults were not able to get an appointment or speak to someone the last time they called their GP surgery, up from 9% in June 2012. People who can’t get a GP appointment often end up at A&E. In January 2015, it was reported that one million patients a year were seeking help in A&E departments as they were unable to get a GP appointment.