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NHS chiefs consider mandatory three-month wait for non-urgent operations to save stretched funds

Cataracts, hip replacements and varicose veins would only be treated within 12 to 18 weeks as funds are targeted to urgent care

Alex Matthews-King

Health Correspondent

Friday 17 November 2017 17:45 GMT

Delays are being justified by "hard choices" NHS areas must make for use of limited funds (Getty Images)

Mandatory minimum three month waits are being considered for all patients undergoing “non-urgent” surgeries such as hip replacements.

NHS clinical commissioning groups (CCGs) said they were considering the move to ensure capacity for urgent care. They added that they wanted to make sure that stretched funds are spent “efficiently and effectively”.

This comes as a letter, sent today by the president and vice-presidents of the Royal College of Surgeons, asked members to prioritise emergency work and return to elective care "in the spring".

Joint replacements are one common form of elective surgery, with patients on waiting lists often living with limited mobility or pain. Cataract operations, and treatment for varicose veins would also be delayed.

The move is being considered by four CCGs in Lincolnshire, as well as Trafford CCG in Greater Manchester, according to the Health Service Journal.

The plan would not necessarily fall foul of the NHS’s, currently unenforced,18-week standard for patients to receive treatment and NHS England did not condemn the move. They said local areas face “difficult choices” with limited funds.

A spokesperson for Lincolnshire CCGs also said “some conditions do get better over time” so NHS resources could be spent elsewhere.

A ruling in 2011 banned the introduction of minimum waiting times, but as CCGs did not exist at this time it is not currently applicable to them.

Everyone the Government blames for the NHS crisis – except themselves

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1/6Everyone the Government blames for the NHS crisis – except themselves

Everyone the Government blames for the NHS crisis – except themselves

The elderly

“We acknowledge that there are pressures on the health service, there are always extra pressures on the NHS in the winter, but we have the added pressures of the ageing population and the growing complex needs of the population,” Theresa May has said. Waits of over 12 hours in A&E among elderly people have more than doubled in two years, according to figures from NHS Digital.

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Everyone the Government blames for the NHS crisis – except themselves

Patients going to A&E instead of seeing their GPs

Jeremy Hunt has called for a “honest discussion with the public about the purpose of A&E departments”, saying that around a third of A&E patients were in hospital unnecessarily. Mr Hunt told Radio 4’s Today programme the NHS now had more doctors, nurses and funding than ever, but explained what he called “very serious problems at some hospitals” by suggesting pressures were increasing in part because people are going to A&Es when they should not. He urged patients to visit their GP for non-emergency illnesses, outlined plans to release time for family doctors to support urgent care work, and said the NHS will soon be able to deliver seven-day access to a GP from 8am to 8pm. But doctors struggling amid a GP recruitment crisis said Mr Hunt’s plans were unrealistic and demanded the Government commit to investing in all areas of the overstretched health service.

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Everyone the Government blames for the NHS crisis – except themselves

Simon Stevens, head of NHS England

Reports that “key members” of Ms May’s team used internal meetings to accuse Simon Stevens, head of NHS England, of being unenthusiastic and unresponsive have been rejected by Downing Street. Mr Stevens had allegedly rejected claims made by Ms May that the NHS had been given more funding than required.

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Everyone the Government blames for the NHS crisis – except themselves

Previous health policy, not funding

In an interview with Sky News’s Sophy Ridge, Ms May acknowledged the NHS faced pressures but said it was a problem that had been “ducked by government over the years”. She refuted the claim that hospitals were tackling a “humanitarian crisis” and said health funding was at record levels. “We asked the NHS a while back to set out what it needed over the next five years in terms of its plan for the future and the funding that it would need,” said the Prime Minister. “They did that, we gave them that funding, in fact we gave them more funding than they required… Funding is now at record levels for the NHS, more money has been going in.” But doctors accused Ms May of being “in denial” about how the lack of additional funding provided for health and social care were behind a spiralling crisis in NHS hospitals.

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Everyone the Government blames for the NHS crisis – except themselves

Target to treat all A&E patients within four hours

Mr Hunt was accused of watering down the flagship target to treat all A&E patients within four hours. The Health Secretary told MPs the promise – introduced by Tony Blair’s government in 2000 – should only be for “those who actually need it”. Amid jeers in the Commons, Mr Hunt said only four other countries pledged to treat all patients within a similar timeframe and all had “less stringent” rules. But Ms May has now said the Government will stand by the four-hour target for A&E, which says 95 per cent of patients must be dealt with within that time frame.

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Everyone the Government blames for the NHS crisis – except themselves

No one

Mr Hunt was accused of “hiding” from the public eye following news of the Red Cross’s comments and didn’t make an official statement for two days. He was also filmed refusing to answer questions from journalists who pursued him down the street yesterday to ask whether he planned to scrap the four-hour A&E waiting time target. Sky News reporter Beth Rigby pressed the Health Secretary on his position on the matter, saying “the public will want to know, Mr Hunt”. “Sorry Beth, I’ve answered questions about this already,” replied Mr Hunt. “But you didn’t answer questions on this. You said it was over-interpreted in the House of Commons and you didn’t want to water it down. Is that what you’re saying?” said Ms Rigby. “It’s very difficult, because how are we going to explain to the public what your intention is, when you change your position and then won’t answer the question, Mr Hunt”. But the Health Secretary maintained his silence until he reached his car and got in.

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Surgeon leaders said this loophole should be closed.

Royal College of Surgeons president Sue Hill said patients in Trafford already wait 7.2 weeks for treatment and under this policy that “would double”.

Ms Hill said: “Under the coalition government minimum waiting times were banned and we urge the present government to reinstate that policy and not force patients to wait a minimum of three months for routine surgery.”

But in a letter to surgeons today, Ms Hill and the college's vice-presidents asked members to focus on emergency care, with elective care having to wait this winter.

"We, the surgical community, must continue to do everything we can to help manage pressures this winter," the letter says.

"By giving proportionally more of our time to support the front door of the hospital we will give ourselves and our patients the best chance of returning elective care to a more reliable footing in the spring."

This comes after Cambridgeshire and Peterborough CCG implemented its own minimum waiting times as part of a wide-ranging “cost management process” in September. They then scrapped it this month.

A spokesperson for the Lincolnshire CCGs said: “The NHS has a responsibility to ensure public money is spent effectively and efficiently. There is evidence that some conditions do get better over time and that, in some cases, surgery may be unnecessary.”

In Trafford, the HSJ reports the plan is under review but a spokesperson said the region is “facing a real financial challenege”.

An NHS England spokesperson said: “CCGs face difficult choices about what can be afforded within the funds Parliament has made available, recognising the priority being accorded to emergency care, mental health, cancer and GP services.

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