Has The Government Buried NHS England’s 18-Week Treatment Target?

13 Aug 2019

In 2004, the Government introduced an 18-week NHS target , so that no patient in England should have to wait longer than 18 weeks from their GP referral to receiving consultant-led treatment. This target is now a legal right applied to both physical and mental health non-urgent conditions:  the clock starts ticking towards the 18 weeks from the time your appointment is booked though the NHS e-Referral System or from  when the required service receives your referral letter.

Despite this legality, the number of patients waiting longer than 18 weeks is currently rising: a  report from January 2017 indicates that at least 10% of patients are currently waiting longer than 18 weeks for vital surgery.

Target? What Target?

The Health Secretary Jeremy Hunt’s answer to the problem of rising wait times was simply to omit the 18-week target from his 2017-2018 mandate for NHS England; the annual mandate  is produced by the Department of Health and outlines the key priorities for NHS England for the coming year. Then to compound matters, in March 2017 Simon Stevens, the NHS England chief executive, announced that the NHS is, ‘significantly relaxing the requirements on hospitals to treat within 18 weeks’.

The upshot of these two tactics is this: while the 18-week target is not formally scrapped, in the future, NHS trusts will not face sanctions for any target breaches.

In response to this administrative sleight of hand, the president of the Royal College of Surgeons said, ‘It will be difficult for the general public to understand how waving the white flag on this target is compatible with a vision of an improved health service. We risk returning to the days of unacceptably long waits for elective surgical treatment’.

Has Jeremy Hunt Broken The Law?

James Goudie QC., a barrister specialising in public law and employment law, stated that any failure to enforce the waiting time target was illegal and for this reason, Jeremy Hunt has broken the law. Goudie’s report, commissioned by Labour peers stated that ,’the 2012 Regulations and the NHS constitution have the effect that (the 18-week target) must be included. The annual mandate cannot lawfully be used to circumvent or undermine by omission the absolute statutory and sub-statutory requirements’. By this rationale, Secretary Hunt’s actions are open to the possibility of a legal challenge.

 Poor Commissioners

Until this legal challenge happens, the excuses will keep coming. Julie Wood, chief executive of NHS Clinical Commissioners was keen to stress that waiting times were only one measure of care quality and that Commissioners were facing increasing pressures on limited resources and tightly restricted budgets. She said that during these difficult times, Commissioners, ‘are having to make increasingly hard decisions to make sure that they provide the […] populations they serve with the best possible healthcare within the overall resources they have’.

Making Choices

In the meantime, waiting times and access to treatment on the NHS are, ‘little short of a postcode lottery’ with, ‘dramatic variations across the country’. According to NHS England itself, the performance of Clinical Commissioning Groups varies widely based on geographical area, with patients in the east and south-east of the country facing the poorest service: NHS Southport and Formby was ranked best overall while NHS Isle of Wight was ranked worse.  What is more, the NHS England results seem to indicate that the wide fluctuation in standards appears to be primarily predicated on how individual Clinical Commissioning Groups are choosing to spend their money rather than any other factor, such as population size .

Hear No Evil, See No Evil

Certainly in a climate of chronic underfunding and strained resources, the NHS will continue to struggle to provide the service it imagines it should. In order to live up to the ideal of high quality care to all citizens, solutions must be derived from many sides, including recruitment, training and technology. Of course all of this requires investment. So, the Government must also make a choice: either correctly identify the problems within the NHS and fix them, or stop pretending that the NHS is the infallible jewel in our country’s crown and lower expectations and targets accordingly. Either is preferable to the current Hunt tactic of dissembling.

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