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Inpatient figures continue to fall but new figures show seven trusts responsible for over a quarter of the outpatie...
Inpatient figures continue to fall but new figures show seven trusts responsible for over a quarter of the outpatients waiting times increase.

Teams from the shadow Modernisation Agency, set up following the government's NHS Plan, will be going into hospitals failing to bring waiting times down, health minister Lord Philip Hunt said today, as the latest figures showed a rise in outpatient waiting times.

The action was announced as the figures showed a wide variation in performance between trusts. The inpatient waiting list fell by 5,000 during June, maintaining the government's commitment to reduce the waiting list by 100,000 for a fourth month in a row.

The outpatients figures for April, May and June - which often show some seasonal rise - drew a mixed picture. The number of people waiting longer than 26 weeks fell by 1,888 over April, May and June, but those waiting more than 13 weeks rose by 42,880. The previous quarter had shown a drop of 94,000.

Just 19 trusts account for over half of the outpatient increase, while only seven trusts account for a quarter of the rise. The seven trusts, all to be visited this week by the agency teams, are:

Aintree Hospitals NHS Trust

Dudley Group of Hospitals NHS Trust

Hull and East Yorkshire Hospitals NHS Trust

Leeds Teaching Hospitals NHS Trust

Plymouth Hospitals NHS Trust

Southend Hospital NHS Trust

Worcester NHS Trust

The teams will go into these hospitals this week applying the forthcoming quality control system, outlined in the NHS Plan, based on the red, yellow and green traffic light status. They will receive special measures - intensive support from the Modernisation Agency, with a recovery plan drawn up specifically to tackle the outpatient problem. The agency will expect dramatic improvements within six


Teams from the National Patient Access Team (NPAT) - which forms the core of the Modernisation Agency - have an excellent track record in turning round trusts failing on waiting lists and times. For example,four trusts (full details below) including Medway and the Royal Liverpool, have just cut their outpatients times after large rises in the previous quarter, with support and advice from NPAT.

Lord Hunt also announced that£40m from the extra Budget resources will be used immediately to boost the war on waiting times.£13m will be allocated to trusts who have spare capacity to domore outpatient work.£27m will be targeted at specialities

with long waits - cataracts, orthopaedics, ear nose and throat and dermatology.

Under the traffic lights system set out in the NHS Plan, green trusts are rewarded with greater independence and financial incentives, while red trusts have regular inspections and external support to help draw up a recovery plan.

Accordingly, any of this extra money set aside for the seven named trusts will now be held by the Modernisation Agency on the trusts' behalf and spent in the trusts on the agency's direction.

Lord Hunt said: 'The public's top concern about the NHS is waiting for treatment and it's excellent news to see the inpatient waiting lists keeping below the 100,000 pledge level. But the outpatients rise has to be tackled with immediate action. There is usually a seasonal rise in these figures, but this increase is far too high.

'Patients in many parts of the country are getting a good deal from the NHS, where waiting lists and times are coming down. We need to ensure that that kind of service is available to everyone, no matter where you live.

'The government, through the NHS Plan, is determined to tackle the underlying causes of the problem, through rewarding good performers and supporting poor ones.

'Through NPAT and innovations such as the traffic light system we will target these trusts and help them to change the way they work. In return we expect to see a dramatic turn-around in their performance.'

Key points of the waiting figures announced today are:

- At the end of June 2000 there were 5,000 fewer patients waiting for NHS inpatient treatment compared to the previous month. There are now 1.048 million patients waiting for operations.

- The number of people waiting longer than 13 weeks for an outpatient

appointment rose by 42,880 during the three months to June.

- The number of people waiting longer than 26 weeks for an outpatient

appointment fell by 1,888 over the same period

- One patient was reported as waiting longer than 18 months for

inpatient treatment

- The number of patients waiting longer than 12 months for an

operation fell by 160 during June to stand at 50,700


1. The waiting list refers to patients waiting for NHS inpatient

treatment. Waiting times refer to patients waiting for a first

appointment with a specialist doctor following referral by their GP.

2. NPAT has made over 100 visits to trusts over the last two years,

helping hospitals bring down their waiting times. For example the

following four trusts have reported improvements in their outpatient

waiting times after NPAT support. The table shows the rise and fall

in the number of people waiting over 13 weeks for their outpatient


April - June 99 Dec 2000 - March 2000

Royal Liverpool and Broadgreen +1,477 -716

University Hospital NHS Trust

North Staffordshire Hospital +1,033 -1,051

NHS Trust

Havering Hospitals NHS Trust +605 -1,208

Medway NHS Trust +949 -975

These improvements were achieved by a combination of:

Development of referral protocols in primary care (particularly in


Establishment of call centres as part of the partial booking

implementation process

Improved data collection, analysis and validation

Review Clinic Templates

Training for Trust staff involved in outpatient services


Main Points This Month

Waiting lists and times

- The total number of patients waiting to be admitted to NHS

hospitals in England fell by 5000 (0.5%) between the end of May 2000

and the end of June 2000 and stood at 1,047,900;

- The total number waiting fell by 46,360 (4.2%) between June 1999

and June 2000;

- The number of English residents waiting over one year at the end

of June fell by 160 (0.3%) since May to 50,700 (the hospital based

figures show a similar trend); this was 2,020 (4.1%) higher than June

1999 when the total was 48,690;

- 1 patient had been waiting for longer than 18 months at the end

of June 2000;


- There were an estimated 2.3 million spells in hospital in the

general & acute sector in the first three months of 2000/01, an

increase of 19,000 (0.8%) over the same period of 1999/00;

- The number of spells in hospital for general and acute elective

patients was estimated to be at the same level in the first three

months of 2000/01 as in the period April to June 1999.

- The number of general and acute non-elective (mainly emergency)

spells in hospital in the first three months of 2000/01 was estimated

to have grown by 1.9% compared with the first three months of


- There were estimated to have been 2.7 million first outpatient

attendances in the general and acute sector between April and June

2000, an increase of 52,000 (2.0%) over the same period in 1999;

- The number of new attendances at accident and emergency

departments in England in the period April to June 2000 was estimated

at 3.3 million, 16,000 (0.5%) more than in the same period in 1999;

- Health authority figures are based on the resident population up to

April 1999 and the responsible population from April onwards, See the

statistical notes for an explantion of the difference.

Statistical Notes

Inpatient waiting lists

Waiting list information is collected from English health authorities

on a responsible population basis (see note on next page) and from

NHS trusts on a provider basis.

In interpreting the figures it should be noted that about half of

patients (not including live babies) treated in hospitals are

emergency cases and do not come from the waiting lists.

This publication contains waiting list information on patients who

are waiting to be admitted for treatment either as a day case or

ordinary admission. It does not include:

- patients admitted as emergency cases

- outpatients

- patients undergoing a planned programme of treatment eg a series

of admissions for chemotherapy

- expectant mothers booked for confinement

- patients already in hospital but included on other waiting lists

- patients who are temporarily suspended from waiting lists for

social reasons or because they are known to be not medically

ready for treatment

Waiting times begin from the date the clinician decided to admit the

patient. Patients subsequently offered a date but unable to attend

have their waiting times calculated from the most recent date

offered. These are known as self-deferred cases and are included in

the total waiting.

The tables include an element of estimation and incorporate all

returns and amendments received from health authorities and trusts up

to 11 May 1999.

Hospital and Health Authority based lists

Responsibility for ensuring that NHS patients are treated as quickly

as possible, and at the very least within 18 months of being put on

the waiting list, lies with commissioners (health authorities and

primary care groups). Information on health authority based waiting

lists has been collected for performance management purposes and is

published here alongside the hospital based figures.

There are fundamental differences in coverage between health authority

based and hospital based information. Health authority based returns

exclude all patients living outside England and all privately funded

patients waiting for treatment in NHS hospitals. However they do

include NHS funded patients, living in England, who are waiting for

treatment in Scotland, Wales and Northern Ireland, abroad, and at

private hospitals; these patients are not included in the

corresponding hospital based returns. Historically there has been a

1% to 3% difference in the overall size of the waiting lists reported

for NHS hospital trusts and health authority residents, the

trust-based figure being the larger.

Change to the basis of Health Authority waiting list/times statistics

from April 1999

From 1st April 1999 Primary Care Groups (PCGs), in partnerships with

their Health Authorities (HAs), are responsible for commissioning

healthcare for their populations. HAs reported their waiting lists

and times data during 1998/99 on the basis of their Resident

Population. In 1999/2000 HAs will report this data on the basis of

their PCG-based Responsible Populations (see note).

The net effect of these changes will be negligible, however the move

to reporting on the basis of Responsible Population may be

significant for some HAs when compared to data previously collected

on the basis of their Resident Population.

This change will not affect the Provider Based statistics collected

from NHS Trusts.


Responsible Population:

- all those patients resident within the HA boundary; plus

- all patients registered with GPs who are members of a PCG for

which the HA is responsible, but are resident in another HA; minus

- any patients resident in the HA, but registered with a GP who is

a member of a PCG responsible to a different HA.

Additional Information

Full details of waiting lists and times for individual health

authorities and trusts are available from the address below.

Waiting Lists Analysis

NHS Executive

Room 4N34

Quarry House

Quarry Hill

Leeds LS2 7UE

Telephone: 0113 254 5455 Fax: 0113 254 5520


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