Plan to hit 18-week NHS wait target 'set to fail'

The government’s plan to tackle the hospital backlog in England will fail without a fundamental reform in how services work, health leaders say.

Labour aims to increase the number of appointments and operations done each week by 40,000, to help hit the 18-week waiting time target.

But NHS Confederation research found that would deliver only about 15% of the extra capacity needed to get back to reaching the target, which has not been hit since 2006.

It called for a wider transformation of hospital care, including greater use of digital technologies to improve productivity.

The warning comes ahead of the release of a government review of NHS performance later this week.

Led by NHS surgeon and independent peer Lord Ara Darzi, the review was ordered by Health Secretary Wes Streeting shortly after the election, to help identify the biggest barriers to improving waiting times.

Sources close to the review said it would be a warts-and-all report, including criticism about the lack of productivity in some areas.

There will also be a warning about the state of children's health, and how that has deteriorated in the past decade.

Data from the upcoming review is expected to show that more than 100,000 infants were left waiting for over six hours in A&E in England last year, while 800,000 children and young people are on NHS waiting lists for hospital treatments.

Dr Mike McKean, Vice President of Policy at the Royal College of Paediatrics and Child Health, told BBC Breakfast that while the review will highlight some issues that apply to adults as well children, "we have simply got our prioritisation wrong here".

"When you think about diseases that adults get - whether it's cancers, dementia or cardiovascular diseases - many of them are because of a lifetime of problems and a lot of them start in childhood.

"If you get it right for children and families… then we know we will have more robust adults who will get less illnesses and diseases," he added.

Sir Keir Starmer referred to Lord Darzi's upcoming review in his first major interview this weekend, telling the BBC the NHS had been "broken" by previous Conservative-led governments.

Fundamental changes

The review is likely to pave the way for an expansion of surgical hubs, which are used to carry out low-complexity, high-volume treatments such as hip replacements and cataract surgery.

This week a study by the Health Foundation think tank said in places where they had been introduced, the number of treatments had risen by a fifth.

Existing hospitals will also be asked to do more, with staff paid time-and-a-half to work weekends to ensure 40,000 more appointments and treatments a week can be done, as promised in Labour’s election manifesto.

But the NHS Confederation research, carried out jointly with consultancy Carnall Farrar, said this alone would not be enough to start hitting the 18-week target again.

Currently the NHS backlog stands at 7.6 million waits, with more than 40% having waited over 18 weeks. The target is for 92% to be seen within 18 weeks.

Matthew Taylor, chief executive of the NHS Confederation, which represents managers, said the scale of the challenge facing the government should not be underestimated.

“Forty-thousand more operations and appointments a week won’t be nearly enough to hit the target. The NHS needs reform, not just ever more activity.”

The NHS Confederation called for fundamental changes, including investment in digital technologies and greater use of robotic surgery and AI.

Significant savings could be achieved through carrying out fewer appointments before and after treatment, it said.

Follow-up checks could be done remotely and in some cases scrapped altogether, leaving it to the patient to decide whether they needed to be seen.

The number of assessments and appointments carried out could also be reduced by joining up care better for the 1.2 million people who are waiting for more than one treatment.

The report also said hospitals had to do better at vetting their waiting lists, warning time was being wasted chasing up patients who no longer needed treatment, either because they had already paid for it privately, decided not to have it or, in some cases, had died.

But it said achieving these productivity improvements would require upfront investment in buildings and technology.

The report also called for more to be done to prevent ill health, to reduce the numbers needing treatment.

The Department of Health and Social Care said improving productivity and investing in technology would be part of its plan, alongside expanding the number of appointments and operations.

"Fixing the NHS will be difficult and will take time, but this government will deliver the investment and reforms needed to turn the service around," its spokesperson added.

Conservative shadow health secretary Victoria Atkins accused Labour of using Lord Darzi's review as "cover" to raise taxes in next month's Budget.

She told Sky News: "They weren't straight with us about winter fuel payments, they're not being straight with us about taxes, and we need to have a grown-up conversation about the NHS, but this is not the way to go about it."

Update 10.9.24: This story has been updated to reflect the 7.6 million NHS backlog is waits for treatment. Some people are waiting for more than one treatment.