RTT data - a window on elective care recovery

IHPN’s Head of Acute Care Policy, John Hopgood, looks at why this month’s Referral-to-Treatment waiting times data carries particular significance for the independent sector.

The monthly publication of data from NHS England this week carries more significance than usual. Not only is it our first chance to have a detailed look at activity since the start of the 2021/22 financial year (and the end of the National Hospitals Contract), but it’s also the biggest indication yet as to where recovery from the pandemic is heading.

To start with, let’s be clear – there are no surprises here. Waiting times are high and rising, waiting lists are long and getting longer, and there are still millions of ‘hidden’ waiters who may be about to push these figures still further into the red.

In April, the official waiting list stood at 5,122,017 people – 30% higher than April 2020, and 19% higher than April 2019. It is the largest official waiting list on record. Behind that startling number, however, sits a perhaps more worrying thought. Since the start of 2020 (and across the pandemic), referrals into elective care pathways have been dramatically lower than would be expected – to the tune of 7.2million people. If the lifting of lockdown restrictions through May and June has signalled even some of these lost referrals presenting themselves, then expect to see the headline waiting list soar higher still before any inroads can be made.

In terms of waiting times, there is more concerning reading. As of April, some 38% of people had been waiting longer than the 18-week target – roughly 1.8million people. For the first time this month, data also provides more insight into the very long waiters – 385,000 people (8% of the waiting list) waiting more than a year, with almost 3,000 of those having waited for more than two years.

So is the recovery off to a slow start, or simply a non-starter? While this data is showing us what the picture was a month and a half ago, its an interesting indicator of where we’re heading. The number of admitted pathways completed in April stood at just 80% of pre-pandemic numbers (April 2019); non-admitted pathways completed was at 89%. Not only do those numbers need to be north of 100% – and quickly – but of more concern is that even with referrals being down, month-on-month, there remains a gap between referrals and activity. But why has there been a slow start?

Well, first and foremost, the NHS itself is still recovering, still translating back from crisis mode to business as usual. Beyond that, though, lies the need for a clear plan that co-ordinates action and energy across the system. No matter how hard healthcare staff are working, sustained recovery will need an alignment of policy, leadership direction, and certainty over funding.

A Guardian report today indicates that No.10 estimate fixing waiting times might cost £40bn and take four years. Those numbers seem like a reasonable starting point – but the real issue is that the actual efforts to tackle waiting times only begin in earnest once that funding is committed and a comprehensive long-term plan in place. That needs to happen as a matter of urgency, and we are communicating that message clearly both to NHSE and government.

And what of the independent sector? It’s vital that any coherent recovery plan has a clearly defined role for the sector – independent providers offer much needed capacity and expertise that will be vital over the coming months and years.

Worryingly, the number of GP referrals to independent providers actually fell slightly in April compared to the previous month, and in absolute terms stood at just 75% of 2019 levels. We have identified a number of significant blockers– issues around the increasing capacity framework, financial uncertainty among NHS Trusts, and delays in reactivating the eRS system are but a few.

A new leadership team came in on NHS England’s electives recovery programme at the end of April, and we’ve been working closely with them to try and address some of these blocks to activity. We are confident that this joint work will lead to real progress on some of those operational blockers and in the short term we’ll start to see patients more easily moving through the system and to providers who have that vitally needed – and currently underused – capacity. Long-term, we need to ensure that independent providers are full partners in the recovery programme so that the whole health system is working together to get people the treatment they need as quickly and efficiently as possible. For that, we need the long-term plan that IHPN called for earlier this week.