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 NHS Reform Monday, 18 February, 2002, 10:43 GMT
Cutting the waits
The public's top concern about the NHS is waiting for treatment. A combination of investment and reform will allow progress on each of these fronts.

Reducing waiting times is the public's biggest priority when it comes to the NHS.

The government's pledge to reduce them is central to its policies to reform the health service.

Target: No patient should have to wait longer than 15 months for surgery by March 2002.

The government more or less met this target. Figures produced days after the deadline showed that just two people were waiting longer than 15 months.

However, it subsequently emerged that some hospitals had fiddled their waiting lists to make it look like they had met the target.

Nevertheless, the target has since been met.

Target: No patient should have to wait longer than six months for an inpatient appointment by 2005

Ministers have so far made steady progress in their attempt to cut waiting times for NHS operations.

However, their aim to cut them to six months by 2005 may prove harder to achieve.

Hospitals will have to significantly increase the number of operations they carry out if they are to meet this target.

Ministers hope new diagnostic and treatment centres will keep them on course.

These centres will offer day surgery to patient waiting for minor operations. They will be stand-alone units, which mean staff, equipment and beds cannot be seconded by other hospital departments.

In recent months, ministers have unveiled increasingly ambitious measures to ensure they meet their targets.

In 2002, they gave the go-ahead for trusts to fly in foreign surgeons to cut waiting lists.

They have also paid for patients to have treatment in hospitals in France and Germany.

In addition, they announced that patients waiting more than six months in certain specialties will be offered the choice of treatment in the private sector.

Target: No patient should be waiting longer than three months for an outpatient appointment by 2005.

This is an ambitious target. In 2001, almost 82,000 people had been waiting more than six months for an outpatients appointment.

An initial target to introduce a maximum waiting time of six months by March 2002 was missed by 500 patients.

Recent figures suggest that three out of four patients are being seen inside 13 weeks.

Target: Patients should not have to wait more than four hours from arrival to admission, transfer or discharge in A&E by 2004.

Ministers say an initial target of 75% of patients waiting four hours or less by March 2002 has been met.

However, an Audit Commission report, published in October 2001, suggested that waits in some A&E departments might actually be getting longer, rather than shortening.

Their examined how many patients had been seen within one hour of arriving at A&E. They found half of patients were still waiting to be seen. This compares to just 38% in 1996.

Hospitals have also come under fire for the way they have tried to meet the government's targets.

Some have been accused of only starting the stopwatch when patients are seen by a nurse and in some cases of keeping patients in ambulances so that they can buy extra time.

Target: By March 2002, all patients admitted to hospital via A&E to be found a bed within four hours of a decision to admit.

This target has proved difficult to achieve. While most hospitals say they have met it, some have been accused of being less than honest about how they achieve it.

In some trusts, patients are put on trolley beds in corridors or make-shift wards beside or even inside A&E departments.

The government has ordered trusts to eliminate this practise.

By 2004 we will end widespread "bed-blocking". All parts of the country will have new intermediate care services. We will introduce new standards to ensure every patient has a discharge plan including an assessment of their care needs

Ministers are committed to tackling so-called 'bed blocking'. This occurs when a patient is well enough to leave hospital but cannot be discharged because they are not well enough to care for themselves at home. In many cases, they are elderly people waiting for a place in nursing homes.

These delays cost the NHS millions of pounds and result in two million beds being lost each year.

The government's initial plan was to create 1,500 new intermediate care beds - "halfway houses" between hospital and home - by April 2002.

It passed that target comfortably and ministers are confident there will be 5,000 places by 2004.

Nevertheless, bed blocking is still a major problem across the NHS. Ministers have now come up with a plan to fine councils if they fail to find appropriate places for these patients. They hope this will act as an incentive for them to tackle the issue.

Target: By 2004, patients will be able to see a primary care professional (for example a practice nurse) within 24 hours, and a GP within 48 hours.

The initial target was for 60% of patients to experience this by March 2002. This has been met.

Ministers remain confident that their full targets will be met. GPs remain sceptical. They have said that thousands more doctors are needed first.

By the end of 2000 NHS Direct, the 24-hour telephone helpline, will have gone nationwide. By 2004 it will be providing health information via digital TV as well as via the telephone and internet.

The helpline is up-and-running in all parts of the country - and there is an internet version too.

A target that, by September 2001, everyone could be directed to a nearby NHS dentist via NHS Direct is more problematic, perhaps due to the general shortage of NHS dentists, although ministers claim it has been met.

A survey carried out in the months leading up to September suggested that in many cases, the helpline was unable to point out suitable dentists in many instances.

A National Audit Office report in January 2002 gave NHS Direct a cautious thumbs up.

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