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NHS reform Thursday, 27 July, 2000, 12:12 GMT 13:12 UK
Six months: A realistic wait?
Ward scene
Waiting is a key area of patient concern
The government wants to make sure no-one waits more than six months for hospital treatment. BBC News Online looks at the obstacles to this ambitious pledge.

Six months might feel like an eternity when a patient is waiting in pain for a vital operation, but in NHS terms it is little more than the blink of an eye.

Until recently it was not at all uncommon in some specialties for people to spend well over a year on the waiting list, not to mention waiting almost as long to even get on the list.

Many separate professionals are needed for even the simplest operation
It is obvious that Tony Blair and his health secretary have looked across at shorter European waiting times and vowed to match them here.

But the finances of the NHS are the similar in size and complexity to those of a small country, and while there are many things that the extra billions can influence, any government embarking on major reform must be wary of unexpected knock-on effects.

And any attempt to dramatically increase the volume of work carried out in the NHS must not be at the expense of quality.

Is the question of waiting times simply a matter of extra money? As with so many other things in the NHS, the answer is yes - in part.

Money can build or re-open extra wards and operating theatres, but these need to be staffed, and new doctors, particularly specialists and surgeons are far harder to come by.

Likewise, operating theatres can be kept running 24 hours a day - but there is both no certainty that the staff can be found to fill them, combined with the fear that delicate operations carried out in the wee small hours may not be completed with the same degree of skill as those during the day.

Time to train

It takes several years to turn a doctor into a fully-fledged surgeon capable of working independently.

Professor George Alberti of the Royal College of Physicians said: "We are pleased that the plan is long-term, as you cannot train new doctors or other health professionals overnight and it will take most of the next decade to achieve the right numbers, but much can be done now."

Nurses are also far more skilled today than they were even a decade ago, and subsequently harder to recruit, retain, and train.

The government's strategy includes encouraging more GPs to carry out minor operations under local anaesthetic at their surgeries, theoretically lifting the load on hospitals.

To free up hospital beds, ministers plan a return to the "cottage hospital" for less desperately ill patients.

patient in bed
Less ill patients could be moved elsewhere
Health analyst Roy Lilley is not in favour of either: "I don't like the idea of GPs doing a little bit - clinical outcomes are better if whoever is doing it is doing a lot.

"Cottage hospitals are dangerous, and expensive to run."

Ministers also want to force some consultants to devote all of their time to the NHS rather than their private work, by rewriting their contracts with a financial incentive to drop their private sessions.

Private problems

However, this appears to conflict with the pledge that anyone whose operation is cancelled for non-medical reasons will have guaranteed surgery, if necessary at a private hospital.

Cancelled operations are endemic in the modern NHS - even if these were substantially reduced by increased NHS capacity, many people would still need to go private, and it is uncertain how a private sector with a lessened supply of consultants would cope.

More radical solutions exist - one, suggested by Professor Lilley, is to enhance the role of hospital technicians within the NHS, so that they were capable even of minor surgery such as cataract operations.

A key question for the government will be when the clock starts running on a patient's waiting time.

Will it be from the moment they are referred by their GP for examination by a specialist, or from the moment that the specialist decides they need the operation? It is almost certain to be the latter.

Pressure to perform in one area - in this case getting operations scheduled and performed quickly, will inevitably impact on other areas, such as the time it takes to get that first specialist appointment.

Waiting to wait

There are already complaints that in some places, it takes just as long to get into the consultant's office in the first place as it does to then get onto the operating table.

The government has already discovered that even a relatively one-dimensional pledge to reduce waiting lists by 100,000 proved desperately difficult to achieve, derailed by even the mildest winter pressures, and creating significant knock-on effects in other areas.

Nigel Edwards, from the NHS Confederation, which represents trust and health authority management, said: "There are no simple and quick fixes for the complex problems of the NHS.

"The constant calls to change the funding mechanism of the NHS run against public opinion and miss the point.

"The Government has been brave to address head-on the really difficult problems facing the NHS."

And although patients may have highlighted waiting times as a key problem in the recent national survey, the public is also keen to see the speedy introduction of expensive new drugs and equipment.

These competing concerns will dilute the effect of the extra billions.

Cancer expert Professor Karol Sikora said: "We have got to have the new technology. This is just catching up - we are well behind Europe."

The wait for much shorter waits may well be a long one.

See also:

19 Jul 00 | NHS reform
19 Jul 00 | NHS reform
19 Jul 00 | NHS reform
27 Jul 00 | NHS reform
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