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The long wait

Betsan Powys | 21:33 UK time, Thursday, 11 March 2010

It used to be a monthly ritual. The publication of Welsh NHS waiting list figures would be a litany of bad tidings, followed by a grilling for the Health Minister and a tale of despair from a patient left languishing for many months, even years on the list.

How things have changed.

Today's waiting time figures for January were published without fanfare. It's the second month for the much-vaunted referral to treatment maximum target of 26 weeks, a target set to almost universal incredulity back in 2005.

So have they hit the target? No. Well no ... and yes.

The One Wales commitment, restating the 2005 pledge, was clear. "We will reduce waiting times to a maximum of 26 weeks from referral to treatment, including all or any waits for therapies and diagnostic tests."

So let's look at today's figures. Of the 231,947 patients waiting for treatment at the end of January 2010, 3,492 were waiting more than 26 weeks and another 35 more than 36 weeks, meaning 98.5 per cent of patients were treated within the target time. This is up from 1,607 and 0 respectively at the end of December, where 99.3 per cent were treated within 26 weeks.

So close, but no cigar, you might think and heading in the wrong direction.

But hang on, say the Assembly Government. The bullet point pledges of a political programme are one thing. The real world is another. There may, they say, be valid clinical reasons why patients cannot be treated within the target time, therefore there are tolerances which should be taken into account. For the overall referral to treatment target then, the tolerance is currently 95 per cent. So, there's a "let" of 5 per cent, if you like, on the target. An excuse for failure, say the opposition. It depends whether you think the tolerance is reasonable in the end, but it does pose a problem for headline writers, at the very least. Remember, the pledge was made back in 2005, the tolerances only came on the scene in August last year.

Today's figures are also broken down into treatment times for patients admitted to hospital and patients treated without being admitted to hospital. Here's a clue about where the pressures lie. Based on the figures for the past two months, if get your treatment without being admitted to hospital, then you have around a one in 55 chance of having waited more than 26 weeks. If you need to be admitted to hospital for treatment, then you have around a one in 13 chance of having waited more than 26 weeks. That's below the 95 per cent tolerance level and a slam dunk missed target.

Of course over the border in England we hear day in day out that patients there only have to wait 18 weeks for their treatment. Sure, it's said, the Welsh NHS has made strides forward but we're still the poor relation.

But wait up. This is where our new friend tolerance comes in.

While it's not possible to directly compare figures between Wales and England, as the data is not collected in exactly the same way, it is possible to get a rough indication of performance between the two, helpfully provided at a briefing on today's waiting list figures.

So with those health warnings in mind, at the end of December 2009:

In Wales, 89.9 per cent of patients waiting were waiting less than 18 weeks.
In England, 90 per cent of patients waiting were waiting less than 18 weeks.

Winner? Wales - by a whisker.

In Wales, 0.7 per cent of patients waiting were waiting over 26 weeks.
In England, 4.5 per cent of patients waiting were waiting over 26 weeks.

Winner? Wales

In Wales, no patients were waiting over 36 weeks.
In England, 47,459 patients were still waiting over 36 weeks.

Winner? No contest.

In England, the tolerance level for their 18 week maximum wait target is set at 90 per cent. So - or so at least the argument goes in Cardiff Bay - what you gain on the time you lose on the tolerance.

There's no great appetite for introducing a target lower than 26 weeks for the Welsh NHS. It's generally felt to be a fair balance between economic reality, patient need, and the capacity of the NHS to deliver. But there's also a sense of realism too.

Let's face it: the 26 week target has only been just about hit/narrowly missed after a big cash injection. Sustaining it in a new world of tightening budgets? Now that's the real challenge, with very little tolerance at all.

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