Richards: NHS must protect waiting times and access to treatment (HSJ: 25 July 2017)

The NHS must protect waiting times for planned treatment and maintain access to evidence based care despite ongoing austerity, the outgoing chief inspector of hospitals has insisted.

Sir Mike Richards, one of the UK’s top medical leaders who has worked at the top level for more than a decade, is retiring at the end of this week.

He told HSJ in an exit interview: ”I would never support restricting access to evidence based care.”

Asked about concerns of national clinical leaders that clinical commissioning groups have introduced some restrictions on elective operations which they believe are not clinically justified, he said: “There are some patients who in the past may have had knee replacements who weren’t… likely to benefit from it, but where there is evidence for it I certainly want us to be able to deliver those treatments.”

He also warned that – with elective waiting lists and times growing – very long waits “mustn’t be allowed to happen again”.

Sir Mike added: “It is worth remembering about the 18 weeks, those that have been around long enough will remember, that why did they choose 18 weeks? Because it used to be 18 months, it is as simple as that. People used to wait 18 months for cardiac surgery.”

NHS England said in March that planned care was not one of the top priorities for the next two years, and that18 week elective waiting time target was, therefore, unlikely to be met.... read more


Thousands of mental health patients spend years on secure wards (20 July 2017)

Thousands of mental health patients are being kept in secure wards for years at a time when they should be being rehabilitated and preparing to leave hospital, a NHS watchdog has revealed.

The Care Quality Commission (CQC) criticised both NHS and for-profit mental health providers for forcing such a large number of patients to endure what it called “outdated and sometimes institutionalised care”, often miles from home. The practice leaves already vulnerable patients feeling isolated and less likely to recover, the CQC warned.

More than 3,500 patients in 248 mental health wards are kept locked-in. In 2015-16 some stayed for 45 days, but others had been there for up to 1,744 days – four and a half years – the care regulator found.

“More than 50 years after the movement to close asylums and large institutions, we were concerned to find examples of outdated and sometimes institutionalised care,” said Paul Lelliott, the CQC’s deputy chief inspector of hospitals.

“We are particularly concerned about the high number of people in ‘locked rehabilitation wards’. These wards are often situated a long way from the patient’s home, meaning people are isolated from their friends and families. In the 21st century, a hospital should never be considered ‘home’ for people with a mental health condition.” ... read more


NHS hospital waiting lists to rise above five million in two years, leak suggests (The Independent: 4 May 2017)

Head of NHS England says longer waiting times are a 'trade off' for improved care elsewhere

The number of NHS patients waiting for hospital treatment could soar to more than five million in just two years' time, a leaked document has revealed.

If no action is taken, twice as many people will be forced to wait more than 18 weeks for non-emergency surgery such as hip replacements and cataract operations by 2019, according to projections made by health service regulator NHS Improvement.

Total waiting list numbers are expected to rise by nearly 50 per cent from 3.7 million to 5.5 million, based on current trends – resulting in delays that surgeons have warned may result in death or serious more


Hospital waiting lists 'will rise above 5 million' as targets slide (The Guardian: 3 May 2017)

Relaxation of 18-week target could mean twice as many people waiting longer for non-essential operations, leaked document reveals.

The number of people in England forced to wait more than 18 weeks for a non-urgent operation could more than double as a result of the NHS’s decision to relax the obligation on hospitals to treat 92% of them in that time, a leaked document has revealed.

The possibility of the backlog rising from 370,000 in February this year to around 800,000 by March 2019 is one of several scenarios sketched out in a presentation to hospital bosses by NHS Improvement, the service’s financial regulator.

Graphs in the document, obtained by the Health Service Journal, indicate that the proportion of patients being seen within 18 weeks could fall from the current 90% to about 85% and the total number of people waiting for planned hospital care for procedures such as hip and knee replacements and cataract removals rise sharply from just less than 4 million to almost 5.5 million. A “sustainable” waiting-list should have no more than 3 million people on it, it more


Revealed: 100,000 wait more than two weeks to see cancer specialist (The Guardian: 18 April 2017)

More than 100,000 patients a year are “having their worst fears dragged out” by having to wait longer than the stated maximum of two weeks to see a cancer specialist to find out if they have the disease, new NHS figures obtained by the Guardian reveal.

A total of 102,697 people in England did not get to see a consultant within 14 days of being urgently referred by their GP last year – a key patient right in the NHS constitution. Some 25,153 people had to wait more than the official target of 62 days to start their treatment.

Macmillan Cancer Support said growing delays to see a specialist, have a diagnostic test and start treatment meant that “thousands of people are being left in an appalling state of limbo”. The Royal College of Radiologists said it feared that long waits beyond the supposed maximums may also reduce patients’ chances of survival and risk some cancers becoming untreatable.

The findings are contained in an analysis of cancer waiting times performance in 2016 undertaken by the House of Commons Library at the request of the shadow health secretary, John Ashworth. “These statistics should be a badge of shame for Theresa May. It’s a national disgrace that this Tory government’s sustained failure to properly fund cancer services has left thousands of patients waiting longer than expected for treatment they urgently need,” he said.

Dr Nicola Strickland, the president of the Royal College of Radiologists, said: “Any delay in diagnosis or time to start therapy risks a growth in the cancer, potentially making it incurable. These delays increase the anxiety experienced by patients and their relatives at this difficult time.”

Diagnostic services’ difficulty in meeting demand means that 230,000 patients a year are also waiting more than a month for the results of X-rays and CT and MRI scans, she said. NHS cancer services are hobbled by chronic shortages of radiologists and clinical oncologists, she said...Read more


Dying patients waiting hours for pain relief in NHS funding shortfall (The Guardian: 14 March 2017)

Dying patients are waiting up to eight hours to receive pain relief because of cuts to district nursing services during the NHS’s unprecedented budget squeeze, a new report has revealed.

Severe financial pressures on the NHS are leading to longer waits for treatment and a short-sighted and growing rationing of care that is storing up problems for the future, according to a study by the King’s Fund health thinktank. 

The report quotes one unnamed manager of a hospice saying: “The district nurses working at night are not able to give effective response times; you can wait up to eight hours … for patients experiencing pain and discomfort in the last two to three days of their life, it has a massive impact. It’s a frightening time for patients.”

The King’s Fund research has found that district nursing and sexual health services are among the areas of care most affected by six years of the NHS in England receiving annual budget increases of 1.2%, far less than its historic average of 3.7% rises.

It highlights how the diminishing number of district nurses are struggling to give patients prompt high-quality care because they are increasingly overworked.

The need to balance budgets and the smaller numbers of district nurses are prompting some NHS bodies to restrict their eligibility criteria for patients seeking help, refusing it for those with serious mobility problems unless they are completely housebound.

“We heard some examples of providers attempting to limit access. This was mainly through tightening referral criteria, particularly in relation to patients being ‘housebound’. Increasingly, if patients are able to visit their general practice (even if doing so is challenging), they will not be eligible to receive care from district nurses,” the report more


Number of patients missing two-month cancer treatment target window doubles amid warnings A&E crisis is sucking away resources (The Telegraph: 8 March 2017)

The number of NHS cancer patients waiting longer than the crucial two-month target window has nearly doubled in the last five years, a new report reveals. Macmillan Cancer support have warned that patients are dying because overrun A&E departments are draining the hospital resources needed to give them the prompt treatment they need.

One in six people diagnosed with the disease began treatment after the aimed-for 62 days in 2016, according to the charity, making it the third consecutive year in which the health service failed to keep pace with rising demand.

NHS England’s Cancer Strategy is supposed to ensure fast access to treatment, however priority for appointments for blood tests and other checks needed before surgery, chemotherapy or radiotherapy is increasingly being given to A&E patients...Read More


Jeremy Hunt urged to intervene after NHS bar stem cell funding for cancer patients (The Mirror: 20 February 2017)

Jeremy Hunt has been urged to intervene on behalf of cancer patients “abandoned” by the NHS in a row over a potentially life-saving treatment it will not fund.

Cancer charity Anthony Nolan wants the Health Secretary to “take action” over a decision barring the health service from funding a second stem cell transplant for patients who have relapsed after an initial transfusion.

Last year NHS England said in a statement on its website that the second treatment was too expensive with a low clinical benefit, meaning it compared poorly with other drugs and treatments.

Polling commissioned by Anthony Nolan and released on Monday as part of its campaign for the second transplants shows two thirds of people believe the NHS should provide the treatment for relapsed patients.

Henny Braund, the charity’s chief executive, said: “It is unacceptable that, despite evidence showing a second transplant is a cure for one in three people, patients are being abandoned against the recommendation, and best efforts, of their doctors...Read More


Retired nurse died after waiting 10 hours for hospital bed following kitchen fall (The Mirror: 17 February 2017) 

A retired nurse died after she waited 10 hours for a hospital bed, an inquest has heard. Margaret Waters, 72, fell in her kitchen and was taken to hospital where she was seen by a doctor. But there was a long delay before she was taken to a ward because of ‘pressure on beds’.

Margaret died 12 days later of a chest infection, caused by impaired mobility as a result of the fall.

During the inquest A&E matron Denise Fraser said the pensioner had been in A&E ‘far longer than ideal’ but within the 12-hour maximum target.

She added: “Due to the pressure on beds over the whole of our winter, we were not immediately able to get her on to a medical ward but she had repeated observation tests.”...Read More


Four in ten patients suffering 'mini-strokes' do not get treatment in time (The Telegraph: 4 December 2016)

Thousands of patients are being put at risk of major strokes because the NHS is failing to give them critical surgery in time, a national audit reveals.

Research by the Royal College of Surgeons shows that more than four in 10 patients who suffer from a “mini-stroke” are not being given vital treatment within the two weeks recommended.

At some trusts, those in need of urgent surgery are being forced to wait an average of almost two months, the study shows.

Charities last night said the variations across the country were “alarming” and fuelling up to 10,000 needless strokes annually.

Every year around 50,000 people in the UK suffer from a transient ischaemic attack (TIA). ...Read More


Ambulance A&E wait times double in Yorkshire (BBC News: 30 November 2016)

The length of time ambulance crews spend waiting to hand over patients at hospital accident and emergency units in Yorkshire has doubled in a year.

Yorkshire Ambulance Service (YAS) figures show medics spent 32,000 hours waiting at A&E departments in 2015-16 compared with 16,000 in 2014-15.

YAS said waiting time "was one of the most significant issues" it faced.

A shortage of available hospital beds has been given as one of the problems causing knock-on delays at A&E. ...Read More


Over 130,000 patients a year are not receiving vital NHS cancer care on time (The Guardian: 7 November 2016)

More than 130,000 patients a year are not receiving vital NHS cancer care on time because hospitals are struggling to look after the growing number of people suspected of having the disease.

Doctors are warning that a widespread and growing failure to meet waiting time targets was causing huge anxiety for patients affected and may even be harming their chances of survival.

A total of 132,138 patients in England last year did not see a cancer specialist within the required 14 days or start treatment such as surgery or radiotherapy within the supposed maximum 31 after diagnosis, or 62 days after initial consultation and tests, according to an analysis of NHS-wide performance data conducted by Cancer Research UK.

Delays in some hospitals were so severe that more than 6,000 patients who should have had their first treatment within 62 days of being urgently referred by their GP last year were forced to wait for 104 days or more, the figures collected by hospitals show. ...Read More


Private companies see profits double while NHS waiting lists increase (Pulse: 27 October 2016)

A major Pulse investigation has revealed that private companies are boosting their profits by up to 100% as the health service struggles to cope.

An analysis of company reports and statements from all the major private hospital chains that make their figures available shows all have boosted their revenues this year.

They say they are gaining from the plight of the NHS, with patients more likely to pay for their care to avoid lengthening NHS waiting lists, which have led to 3.7 million NHS patients wait for treatment – the most since December 2007.

The investigation – the most comprehensive since the introduction of the Health and Social Care in 2012 – also shows that local commissioners are paying hundreds of millions to private hospitals and that hospitals have also boosted their income from private work. ..Read More.


RNIB report: Patients in England face 15-month wait for cataract surgery (The Guardian: 21 September 2016)

Patients in England are having to wait up to 15 months to have cataracts removed from their eyes amid increasing rationing linked to the NHS’s deepening financial woes, a new report has revealed.

People in the north London borough of Enfield face the longest wait – 467 days – between being referred for cataract surgery and actually having it, according to research by the charity RNIB published on Wednesday.

That is more than double the longest delay – 222 days – the RNIB found when it first examined waiting times for the procedure in England in 2013. That occured in Heywood, Middleton and Rochdale in greater Manchester

Other areas with notably long waits include those covered by the GP-led NHS clinical commissioning group (CCG) in Swindon (180 days), Havering in Essex (176 days) and Southampton (174 days).

Long delays caused by the NHS’s drive for “efficiency savings” are causing misery for the mainly elderly patients troubled with cataracts, the RNIB more


NHS finance chiefs warn of poorer care and longer waiting times (The Guardian: 5 July 2016)

NHS finance managers warn today that patients are set to experience poorer care, longer waiting times for treatment and greater rationing.

A grim outlook for the NHS’s finances is also likely to see many hospitals fail to make savings that ministers have said are vital and put plans for the service to reform how it operates in serious doubt. More than one in five (22%) of over 200 NHS finance directors in hospitals and GP-led clinical commissioning groups (CCGs) across England surveyed by the Healthcare Financial Management Association (HFMA) believe that quality of care will worsen during 2016-17. That 22% is a sharp increase on the 9% who voiced that fear as recently as last November.

Even more finance directors – one in three – fear that care will deteriorate in 2017-18 as a direct result of the NHS’s unprecedented financial struggles.

“Fears around the impact the current financial turmoil in the NHS could have on quality are a real cause for concern and we may start to see more of these predictions come true in the year ahead,” said Paul Briddock, the director of policy at the HFMA, which represents NHS finance managers.

“Respondents from both sectors felt waiting times (76%), access to services (69%) and the range of services offered (61%) were the most vulnerable” due to the financial squeeze, according to the HFMA’s latest biannual “NHS financial temperature check” report.

The HFMA’s findings raise questions about the likelihood of NHS trusts in England keeping their overspend for 2016-17 to the £250m they have been told to adhere to and the service getting its finances back into the black after providers of care ran up a deficit of £2.45bn last more


Teaching hospital discovers dozens of year-plus waiters (HSJ: 17 June 2016)

Imperial College Healthcare Trust has declared 47 patients who have waited more than a year for elective treatment, latest board papers reveal.

The teaching hospital said that at the end of March it had 47 patients who had waited over a year – some it already knew about but “the majority” were discovered after a review of records.

The trust said most of the year-long waiters ‘had not been tracked consistently’

A report to the most recent board meeting said: “A minority of these 47 patients are patients whom we had been reviewing regularly, but whose treatment took longer than it should have done because of capacity problems and in some cases also because patients had chosen to postpone appointments or operations.

“However, the majority of the 47 patients waiting over 52 weeks are patients whom we had not been tracking consistently. This is because we had applied referral to treatment rules incorrectly at an earlier stage of the patient’s treatment pathway.” more


Cancer wait performance declines significantly in London (HSJ: 6 April 2016)

The latest cancer data shows a significant decline in waiting times performance for north London boroughs.

The five clinical commissioning groups showing the steepest declines in performance on the 62 day referral to treatment time target over the past four years all sit within the UCLPartners catchment area covering north central and north east London.

Haringey CCG said responsibility rested with its main provider North Middlesex

The target is for 85 per cent of patients to receive their first definitive treatment within 62 days. Falls of 10 percentage points or more between quarter three 2012-13 and quarter three 2015-16 were seen at Enfield, Haringey, Camden, Barnet and Havering clinical commissioning groups in this period.

In quarter three of 2013-14 all of these except Enfield were hitting the 85 per cent target, now none of them are.

South east London CCGs saw the second steepest decline in more


Hundreds more hidden patients waiting 52 weeks for treatment (HSJ: 17 March 2016)

At least 378 more patients than previously thought have been waiting a year or more for planned treatment, HSJ has uncovered. The most recent official NHS England data, for January, shows 722 patients in England waiting 52 weeks or more for treatment. However, this does not cover waiting lists at nine hospital trusts which have been allowed to stop reporting data.

HSJ revealed earlier this month that 1,015 patients were waiting more than a year for treatment at Barking, Havering and Redbridge University Hospitals Trust at the end of January.

We have now established that, across six of the other non-reporting trusts, there were a further 378 patients in this more 


NHS records worst ever performance figures (The Guardian: 10 March 2016)

The NHS recorded its worst ever performance in the first month of the year as services struggled to cope with unprecedented demand for A&E care, hospital beds and ambulances.

Hundreds of thousands of patients were forced to wait longer than they should for time-critical care as the NHS missed almost all its key waiting time targets.

The latest monthly performance data, released on Thursday by NHS England, shows that hospitals buckled badly during January, partly because the traditional “winter pressures” arrived later than usual.

A total of 212,136 patients waited more than the maximum four hours to be admitted, transferred or discharged from hospital A&E units – the highest number ever. Hospitals only treated 83% of A&E patients within four hours, way below the 95% standard they are meant to more


'I didn't matter': the long wait for mental health treatment (The Guardian: 25 January 2016)

I’ve always been a worrier, back into my teens,” said Helen Convery, 43, a radiographer from Epsom who has seen the best and the worst of the NHS’s Improving Access to Psychological Therapies (IAPT) programme.

Her most recent mental health problems emerged, as in so many cases, when she was engulfed by a pile-up of problems in her life. Last summer, her husband’s illness had returned, her father was diagnosed with terminal cancer and she herself had been diagnosed with health problems.

“All three things happened in the space of a couple of months,” she said. “I had a breakdown.” The crunch point came when she could not cope with the routine chore of washing clothes any more.


Her first brush with depression had been in 2006, before IAPT existed. But then in 2012 an illness her husband suffered and relationship issues caused her serious anxiety. She was tearful, tired and kept cancelling social engagements at the last minute. Her GP put her on antidepressants and warned her there would be a long wait for the IAPT consultation that was supposed to give her access to talking therapies on the NHS.

“I didn’t hear anything for three months,” she said. “I thought I had fallen through the system.” more


Patients 'waiting three years for gender identity clinic consultations' (Independent: 12 December 2015)

The portrayal of transgender characters and issues in mainstream media has triggered a surge in demand for services provided by gender identity clinics, experts say.

Patients now have to wait up to three years to be seen at a gender identity clinic (GIC), a phenomenon that can be partly attributed to transgender issues featuring in programmes such as EastEnders and high-profile figures such as Caitlyn Jenner promoting transgender rights. 

Average waiting times for someone referred to a GIC in England have risen to between 12-18 months, according to UK Trans Info, as the NHS struggles to cope with the increase.

There are currently only seven adult GICs across the whole of England: one in London catering for the whole of London and the South-east; one each in Sheffield, Leeds and Newcastle, covering the North; one each in Daventry and Nottingham, covering the Midlands; and one in Exeter for the South-west.

Waiting times at the Leeds GIC are the worst, having trebled from 62 to 182 weeks in the 12 months to September this year, said UK Trans Info, which collates data from clinics every quarter. The waiting list in England has increased by 1,000 in England alone over the past six months.

There are now more than 4,000 people on GIC waiting lists across the UK. Almost half of those are waiting to be seen at the West London GIC at Charing Cross Hospital in London, the busiest in the country. The number of people having their first appointment in England between May and July this year rose by 51 per cent, yet waiting lists across all GICs in England still rose 35 per cent on average in the same period. Scotland has four GICs and Northern Ireland one, where waiting times varied between six and 56 more


NHS pressure increases as A&E waiting times INCREASE with 12 per cent waiting over four hours (The Mirror: 28 November 2015)

Fewer people are seen within four hours due to so called 'bed blockers' who cannot leave because there is not the right social care in the community for them

A&E waiting times are getting worse according to a new study with elderly and frail people occupying hospital beds because there is nowhere else for them to go. Shocking new figures reveal more patients are having to wait more than four hours for treatment as pressure on the NHS intensifies.

Figures collected by the Royal College of Emergency Medicine (RCEM) over the last seven weeks showed at worst 88% of A&E patients were treated or admitted within that time frame - below the government target of 95%. The waiting time target is widely regarded as a key measure of how the NHS is performing. The data from the Royal College of Emergency Medicine is based on evidence submitted by more than 40 health trusts - one in five of the total in the more


NHS waiting times for elective surgery spiked last year, report finds (The Guardian: 24 July 2015)

Delays faced by patients for common forms of surgery increased sharply last year, with those referred for hernia repairs or removal of cataracts, tonsils or adenoids now waiting about a month longer than in 2010, NHS statistics show.

The waiting time for seven key procedures in England now ranges from 91 days, for gallstone removal, to 107 days, for a knee replacement. In just a year, the average waiting time for cataracts removal rose by a third (24 days) compared with 2013.

The Patients Association, which is publishing the data online on Saturday, said its analysis suggests 50,000 people waited longer than 18 weeks for at least one of the procedures, which also included hip replacement, last year. Under the NHS constitution, everyone has a right to receive elective surgical treatment within 18 weeks after being referred by their more


Eating disorder patients' lives at risk due to long waits for NHS treatment (14 June 2015: Guardian)

The lives of people seriously ill with eating disorders are being put at risk because they have to wait up to three years for NHS treatment.

Experts warn that specialist services are struggling to cope with a growing caseload and are so overstretched they have to prioritise patients with anorexia, because they are at greatest risk, ahead of those with bulimia – even though their condition is seriously affecting their lives.

Patients forced to endure long delays are at greater risk of serious damage to their health because it deteriorates while they are waiting. They also have a smaller chance of making a full recovery.


Patients stuck in A&E for up to 46 hours - the number of hospitals recording A&E stays of more than 20 hours has doubled in just one year, a Telegraph investigation discloses (The Telegraph: 26 April 2015)

Patients are being forced to endure stays of up to two days in Accident & Emergency departments amid a growing crisis as NHS beds run out. A Telegraph investigation discloses that the number of hospitals admitting to A&E delays of at least 20 hours has doubled in just one year.

The figures show that this winter, one in three NHS trusts recorded times at least this long – with some patients stuck in casualty units for as long as 46 hours.

The previous year, one in six trusts had patients whose time in A&E exceeded 20 hours, the Freedom of Information disclosures show. Charities said the revelations were “alarming” and “extraordinary” and evidence of a growing crisis, with hospitals now regularly running out of beds as they became crammed with patients.

Levels of “bed-blocking” reached a record high this winter, with rising numbers of elderly people stuck on hospital wards because of a lack of social care services to help them at home. Latest published figures show hospital occupancy levels reached a record high in the last three months of last year - at 89.5 per cent. The recommended safe maximum is 85 per cent, to reduce the risk of infection, but some hospitals reached levels of 99.5 per cent in the run-up to Christmas, it can be more


A&E performance sinks to new low (Guardian: 9 January 2015)

Hospital A&E performance sank to a fresh low over the new year, with NHS England statistics showing that emergency departments across England managed to treat just 79.8% of patients within the four-hour target.

The performance during the seven days to last Sunday was officially the worst ever. The figures, released three days after the publication of data showing that A&E waiting time performance had slumped just before Christmas, put the coalition under renewed pressure over the NHS.

Other figures from NHS England, which reveal a sharp escalation in other problems over the festive period, especially in the week including and just after the new year, indicate the service was on the brink of a winter crisis.

Ambulances had to queue for at least 30 minutes outside an A&E unit in England on 29,388 occasions in the three weeks between 15 December and 4 January, unable to hand over their patients to A&E staff because the emergency department was too busy.

That was more than double the 12,615 such incidents in the comparable three weeks in the winter of 2013-14.


Archive of older stories



More on quality: 







Trends in reported problems

cost cutting

cuts in services


financial insecurity


Examples of problems (by provider)

BMI/Netcare - childrens surgery halted 

Care UK - patients discharged before they are treated

Carrillion - 6 patients feared sight loss

Harmoni (Care UK) - out-of-hours service alleged "unsafe"

Netcare -Celia Collet tells of her poor care

Serco - not enough staff and "fiddled" figures

         - NHS lab failings

PIP - breast implant scandal

Virgin - understaffing at Kings Health Centre




Share your examples about the impact of NHS changes - in a community d/base


Recent reports:

The A&E Winter Crisis: lessons from last year

Nuffield Trust report on the reasons for the A&E crisis in winter 2014/2015

Mental Health Under Pressure

Report into the state of NHS mental health services by Helen Gilburt of The King's Fund - November 2015

The State of Healthcare and adult social care in England 2014/2015

The Care Quality Commission's annual report

Quarterly survey of NHS financial directors by The King's Fund - February 2013 report

‘Making it better? Assuring high-quality care in the NHS

NHS Confederation discussion paper on the quality of care in NHS following the Francis report - February 2013

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