No clear evidence of a significant fall in average waiting times

What I would say to patients what matters is how long they’re waiting, they’re not really worried about who else is on the waiting list, they want to know when their procedure or operation is happening […] The length of time that people are waiting for their procedures is actually going down

In the last few months, we’ve drastically reduced that length of time of waiting […] we’re able to say confidently that we are getting that length of time down.

In a series of broadcast interviews on Sky News, LBC, GB News and Times Radio on 5 July, the health minister Maria Caulfield said that the waiting time for elective treatment in England was being “drastically reduced”.

The Department for Health and Social Care (DHSC) told Full Fact that Ms Caulfield was talking about the reduction in the number of people experiencing waits of more than 18 months or two years, something the minister also mentioned during her interviews.

While the number of cases involving the very longest waits has come down significantly, this does not mean that people are facing shorter waits overall, as she said.

Seasonal patterns make the trend in waiting times difficult to interpret, but the latest public data when Ms Caulfield was speaking does not clearly show that the average waiting time is getting substantially shorter. 

The median wait for treatment in NHS England remains extremely long by historic standards—longer than it was a year ago, or when the elective recovery plan was announced, in February 2022.

The median wait has shortened slightly since the winter, but this may be a seasonal effect. 

Politicians must be clear what they mean when making claims using official data to describe public services. Otherwise they risk misleading people about the government’s performance—or, in this case, access to health care.

Health policy is devolved, so this article only looks at waiting times in England, which is the part of the UK health system that the UK government controls.

What is the NHS waiting list?

When someone is referred for treatment in NHS England, this starts a clock, which stops either when their treatment begins or when a decision is made not to provide it. This can be a complex process, perhaps involving several tests and appointments.

NHS England calls this period of time—between a referral and the beginning of treatment or a decision not to treat—a “pathway”. 

At any given time, many thousands of people will be on a pathway. Because these people are still waiting, their pathway is “incomplete”. (Some may be on more than one, if they’ve been referred for treatment for more than one condition, but the NHS itself often refers to the number of pathways as the number of patients to simplify the language.) 

The total number of incomplete pathways is published by NHS England each month, and is often simply called “the waiting list”. We wrote about this overall list last month.

So are waiting times improving?

Ms Caulfield said the government was confident that waiting times were getting “drastically” shorter. During her interview on LBC, she said this had happened “in the last few months”.

On Sky News, Ms Caulfield cited the reduction in extremely long waits, which DHSC later told us was the basis for her claim. Ms Caulfield said: “We’ve virtually eliminated the two-year wait… We’ve got the two-year waits down, we’ve got the 18-month waits down, and we’re now working on those waiting for a year.”

While this is largely true, these extremely long waits make up only a small proportion of the picture, and reducing them does not necessarily mean that waiting times are getting shorter for patients on the whole.

NHS England publishes an estimate for this data, showing the median number of weeks waited so far, for each incomplete pathway. (The median means the middle value in an ordered list. NHS England uses the median because it is “less susceptible to extreme values than the mean”.) 

The NHS also publishes the median wait for completed pathways, both for when someone was admitted to hospital, and when they weren’t.

Looking at patients who are still waiting, it is clear that the median waiting time has lengthened significantly since the start of the pandemic—but also that it often rises and falls by small amounts from month to month.   

NHS England itself warns against drawing simple conclusions based on short-term changes in this data, saying: “Care should be taken when making month-on-month comparisons of these figures as measures of waiting time performance are subject to seasonality. 

“For example, adverse weather during winter may change the balance between elective and emergency care. Similarly, the number of patients starting treatment will be influenced by the number of working days in the calendar month.”

Looking at the longer-term by comparing each month with the same month in recent calendar years shows how waits increased at the beginning of the pandemic, and remain among the highest in the recent past.

While the median wait at the end of April 2023 was slightly shorter than it was in the winter immediately preceding it, it was still higher than April 2022 or April 2021. 

Based on this, it is potentially misleading to claim that the length of time people are waiting is improving, let alone improving drastically.

Image courtesy of Chris McAndrew