by Hannah Farrell
Although people in the UK do not have the right to demand treatment, they do have the legal right to receive appropriate treatment within a set timeframe, as stated in the NHS Constitution. Whilst the NHS strives to deliver the best care to the public within increasingly difficult circumstances and strained resources, it is important to know what waiting times can be expected and to be aware of delays in treatment.
What is the NHS Constitution?
Put simply, the NHS Constitution is a document that outlines the principles and values of the NHS in England. Within this is states that patients:
“Have the right to access certain services commissioned by NHS bodies within maximum waiting times, or for the NHS to take all reasonable steps to offer a range of suitable alternative providers if this is not possible.”
How long does the NHS expect patients to wait?
For non-emergency treatment, the NHS Constitution expects all patients to wait no longer than 18 weeks from the point of GP referral being received by the hospital to the date of first consultant-led treatment.
Exceptions to the above include:
- Suspected cancer referrals (see below)
- Maternity services
- Mental health services that are not consultant-led
- Public health services
How does the NHS track waiting times?
A patient’s journey to treatment will often be referred to as a ‘clock’. This clock refers to the time in which a patient referral is first received by the hospital, to the time in which the patient starts their first treatment under a consultant-led service. In technical terms, the ‘clock’ is known as the ‘RTT’ or ‘referral to treatment’ waiting time. The Department of Health has established specific rules for stopping and starting this clock in order to ensure fairness and consistency of treatment.
What starts the clock?
The clock starts at the point the hospital receives the referral from the GP, either by formal referral process or a referral letter, or when a patient books their first appointment through the NHS e-Referral Service. The clock also starts when a patient is referred to an interface service i.e., a service which may then refer the patient on to a consultant-led service.
What stops the clock?
There are various scenarios which would stop the clock.
- If a clinician decides no treatment is necessary.
- If a patient declines treatment. This also includes if a patient fails to attend an appointment (DNA’s).
- Treatment is commenced.
The clock may also be stopped in circumstances where it is agreed that it is in the patient’s best clinical interests to wait for treatment to commence. Examples of this include:
- A patient would have a better surgical outcome if they quit smoking before undergoing surgery.
- A patient should undergo a series of psychological therapies before being considered for medication prescribed by a Consultant Psychiatrist.
- It is agreed to start a period of active monitoring of the patient’s condition.
How long should a person expect to wait for a referral for suspected cancer?
The NHS has identified that delivering timely cancer pathways is crucial for improving survival and delivering quality cancer treatments.
The NHS has defined a cancer pathway as:
“A Cancer Pathway is the patient’s journey from the initial suspicion of cancer through Clinical Investigations, patient diagnosis and treatment.”
The cancer pathway may be started in various situations:
- The patient’s GP suspects a diagnosis of cancer and creates a referral.
- A patient is assessed in an Emergency Department and suspected to have a diagnosis of cancer.
- A incidental finding whilst the patient is already undergoing hospital treatment.
- A screening programme identifies a suspected cancer.
Up until recent years, patient’s suspected of having cancer were given a “two week wait” i.e., they would expect to wait up to two weeks to be seen by a consultant-led service to undergo the initial investigation for cancer.
However, in 2019, the NHS began rolling out a new scheme known as “The Faster Diagnosis Standard”. The aim of this new scheme is to ensure people are either given their diagnosis or cancer or had the diagnosis of cancer ruled out within 28 days of their initial referral.
The NHS also state that no patient should wait longer than 62 days from the date of referral to the start of their first treatment for cancer. It is also stated that a patient should not wait longer than 31 days between agreeing the treatment plan and commencing the first treatment.
Ambulance Wait Times
Naturally, people who require immediate assistance and call 999 can expect to receive initial treatment much more rapidly.
Ambulance call handlers are trained to ask specific questions in order to be able to place the call in one of four categories. The categories are outlined below:
Category 1
Where there is an immediate threat to life, for example, cardiac arrest, respiratory arrest, anaphylaxis, severe asthma attack, obstetric emergency, septic shock.
An average response time of 7 minutes is aimed for.
Category 2
Where there is a very serious condition which requires rapid assessment and/or urgent transport, for example, stroke, chest pain, acute abdomen, acute ischaemic limb (critical limb ischaemia), acute pancreatitis, major gastrointestinal bleed, patients with COVID-19 and suspected silent hypoxia.
An average response time of 18 minutes is aimed for.
Category 3
An urgent condition that requires treatment and transport to an acute unit.
It is aimed for the majority of these to be responded to within 120 minutes.
Category 4
A non-urgent stable condition which requires treatment in a hospital clinic or ward.
It is aimed for the majority of these to be responded to within 180 minutes.