Waiting lists: the return of a chronic condition?

Tom Moberly, UK Editor, The BMJ

From 2000 to 2010 the introduction of a wide range of focused initiatives led to a sharp decline in waiting times for elective care in the NHS. The average wait for inpatient treatment fell from over 13 weeks in 1997 to 4.5 weeks in 2009.10 The experience of the people involved in that work, and those who have studied it, informed a recent King’s Fund report on strategies to reduce elective care waiting times now.11

At the report’s launch Paul Corrigan, a special adviser on health to the former Labour government, pointed out that the government initially had to make the case for why long waits mattered before it went about developing policies to tackle them.12 “Although these reforms are looked at as sets of policies, what actually they were, as far as the government was concerned, were sets of arguments,” he said. “You really needed time to persuade both the NHS and the wider public that these things would work and that they mattered.

“The best argument that had to be had was that long waits mattered; the NHS saw them as simply part of the world. It took a solid year of row after row after row to say, ‘This matters.’ It took a year, but now there are very few people in the NHS who say long waits don’t matter.”

It then took the best part of a decade to make substantial progress on reducing waiting times, Corrigan said, but the initial, incremental progress was important in showing people that improvements could be made. He said, “Every long march starts from the short step, and that short step can be experienced by a frontline member of staff as a big breakthrough.

“We were facing an NHS that fundamentally believed long waits were there for ever and always have been, and that was it. Actually, just getting some of that movement had a dramatic impact and got momentum.”

That initial momentum, together with the knowledge that there was a long term plan to support the work, gave people optimism that they could deliver the changes required—that it was “doable, rather than it’s all impossible,” Corrigan said. “It does involve a 10 year plan, because that’s hope,” he said. “It’s how we motivate and applaud that motivation and celebrate that motivation at a time of extreme despair.

“That’s not easy, but I think it’s incredibly doable. It’s how we turn a moment of despair into a moment of hope and say, ‘We’ve done this, we can do it again.’”

Also speaking at the launch of the report, Nicola Blythe, a researcher in the policy team at the health think tank the King’s Fund, said it was clear from the interviews she did for the report that those involved in delivering the 2000-10 reduction in waiting times had recognised the need to develop the workforce. “What we’re talking about is . . . investment in people, a recognition that people would be the means to the end of 18 week waits: having enough of them but also ensuring that those people feel supported and valued to be able to work towards that very ambitious ask time,” she said.

“It was striking to me, at least in the interviews we did with these experts, particularly those who were closer to central policy making at the time in the Treasury, that when we asked questions about cost effectiveness and value for money the responses were quite surprising, in that that wasn’t the question necessarily posed to them at the time,” she said. “There was an acceptance that achieving an 18 week target would require additional resources and people. The question put to them was less how can you make the case for the money for this, [it] was how are you going to resource this effectively, and have you spoken to the workforce directorate within the Department of Health about how this is going to be resourced and achieved.”