What goes down, may also be up

GO FIGURE
Different ways of seeing stats

Hospital waiting times are coming down, right? Well yes, but also no. Once again it all depends on how you do the counting, says Michael Blastland in his regular column.

It's been a proud and justifiable government boast: no one nowadays is left to stew in discomfort for years on end waiting for a hospital to bless them with an op.

The convenient shorthand for this big improvement in maximum waits - from 18-months a few years ago to an 18-week target now - is that "waiting times have plunged".

Have they? Maybe, maybe not. Recent data raises doubts.

For some, that'll be a surprise that makes no sense. Click through the storyboard to see how it works.

The median patient [the patient in the middle of all waits], waited 42 days last year compared with 41 when Labour came to power, according to the Hospital Episode Statistics [HES] for England. In 2004-5 this had gone up by 11 days. It fell back towards '97 levels only last year.

But haven't waiting times been falling sharply? Yes, for the people who have been waiting longest. Let's imagine that the maximum wait is 6 months. Some are kept waiting up to that limit. Most bunch around the middle. Red is one of those. His wait is typical: about 45 days.

Then let's say the government forces down the maximum wait. Some waits are now shorter [in blue]. But this makes no difference to Red. He waits just as long as before - and so do most of the others. Cuts at the top need make no difference to the middle.

Shorter waiting times may be true for some, but not for all - and not necessarily true for the typical patient, nor for the majority. In fact, the patient in the middle could even wait longer, which is what the latest HES data suggests has happened.

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These figures are for England, but Scotland and Wales seem to tell much the same story: median waiting times in the hospital episode statistics (HES) that first rise and then fall back only recently.

Average NHS wait up under Labour

The government tends not to quote this data. Its emphasis has been on maximum waiting time targets. But it does also have its own Department of Health figures for what's happened to the middle. These show a striking improvement (see graph, right).

The reasons for the huge differences back in 1997 (41 days versus 99 days) are not obvious. Still, the government figures and the HES figures are now not far apart, the smaller differences now are more easily explained, and they are going in the same direction.

Since they are now closer to agreement, it could be that we can be a little more confident of what's happening. Maybe cuts at the top - which are becoming ever more demanding - are at last conclusively bearing down on the middle too, whichever way you measure it. After years of effort, is this the moment, finally, that we reach the point of unambiguous improvement for Red and the millions like him?

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Below is a selection of your comments.

I suffer from anorexia nervosa. The NHS eating disorder clinic in my area has assessed me and deemed that I do in fact need treatment, but I've been waiting three months so far for treatment and could be waiting another three or more. Waiting times for operations may have gone down, but as far as I can see waiting times for specialist services are insanely long. In the meantime, my life is an absolute misery - all because there aren't enough spaces for eating disorder patients who aren't minutes away from dying.
Francesca, Leicester

Who uses the Median as a measurement anyway? The whole point of this achievement is that the worst extremes have been dramatically reduced, so that NO ONE waits more than 6 months for treatment now. That is the real achievement here.
Mark Herriot, London

I've no complaint about waiting times for hospital appointments but was recently referred by my GP to a local hospital as an emergency (he feared I had suffered an embolism). I arrived at the Medical Assessment Unit at 4:22pm, was seen by a triage nurse at 7:30pm and seen by a junior doctor at just before midnight. I was finally discharged at just after 1:00am. Target time to see a doctor - 4 hours. Time I had to wait to see a doctor - over 7 hours. Staff were all excellent but the system needs serious attention.
Liz Gardiner, Monmouthshire

My 4 yr old son has been under the ENT department since he was 18 months old, he had sleep apnoea so had his tonsils & adenoids removed & grommits in his ears. I hassled the consultants secretary for weeks as we were told he was an urgent case & when they finally did the sleep study he was called straight in as he needed to be monitored. He is now supposed to have follows ups every 9 months, we get the date & then the app is cancelled again & again. We have an appointment for July, 18 months after his last check up as long as they don't cancel that one either. If they make the appointment, they make the waiting list targets, they just don't keep the appointment.
Lisa Price, Southampton

I prefer to look at hospital waiting times in more realistic terms than numbers. I was told I would be waiting 6-8 months for a big bunch of extractions in hospital which would enable me to retain further use of non damaged teeth. 13 months down the line i've got more holes in my mouth than when I started, and have lost the ability to eat crunchy foods. So I prefer to look at hospital waiting times as such: If you're told you have to wait, don't expect to have anything done. Ever, or at least not until it's too late, even if you can't eat because of it.
John Knight, Neath, S. Wales

Yeah.. I was on a 6 month fast track surgical waiting list 5 years.. that's right.. FIVE years ago!!. Due to a clerical error in updating my records I was dropped from the lists and I am still waiting for my surgery. I have been waiting longer that the allowed 18 weeks now to see the initial consultant again.. Can anybody spell neglect?
joolz, wigan uk

My appointment to see a consultant has been cancelled and moved three times so far. I'm still waiting. Do the figures include this? I doubt it.
Barbara Scott, Dagenham

What's the big deal about hospital waiting list. What's important is waiting in general. I had tried to get CBT (Cognitive behavioural therapy) in Wokingham and it's well over 18 months waiting list. The doctor just talks you out of going on the list as it's pointless!
Mike Bilsborough,

What a typical BBC mealy-mouthed take on NHS good news! Is there nobody there that feels just a little bit anxious about your determined crusade to prove - by whatever convoluted logic you can dredge up - that everything to do with the NHS is rotten? Jack Heery
Jack Heery, Wirral

I think we're getting better at massaging the numbers but my own experience has been one of getting bounced backwards and forwards through a disastrous appointment booking system and getting told that the "18 weeks" hasn't even started yet. When someone does hit that 18 weeks limit then they get shipped off to a private hospital at great expense. Very nice for an occasional lucky patient and no doubt very nice if you own a private hospital, but I doubt it helps Joe average very much.
Ian Nartowicz, Stockport, England

How about the weeks and weeks of waiting as a number of tests are carried out BEFORE one gets on the waiting list ? It's there that the time passes - 6 weeks for this test, 3 weeks for its result, another 6 weeks for the next test and so on. No wonder we have such a poor record for cancer recovery etc
Jackie Staniforth, Croydon, UK

I injured my knee last January and wasn't treated for 10 months. The 18 week target was satisfied (multiple times) as I had appointments with various different medical professionals throughout that period to assess my injury. I felt that many of these appointments were used to delay the time of actually treating me whilst still satisfying targets, particularly as the surgeon who operated on my knee was able to identify the problem within minutes of examining the joint. As a consequence of waiting 10 months, I now have pemanent damage to my knee that cannot be repaired .

Maybe there should be some figures published that show waiting times to treatment rather than simply being seen by a doctor.
Claire Massow, Bristol

My Dad is finally going for his hip operation in April. This is after 3 YEARS of constant pain. They simply don't put you on the list until it's low enough, they make stupid excuses like blood pressure (was low for his age, they said high), cholesterol (same), weight (how does a nearly-crippled person do exercise anyway?). None of these things have changed, all of a sudden he's allowed to have the operation. Why? Because there's a space on the list. Middlesbrough PCT probably look really good on the graphs, but it's all lies. In reality people are waiting even longer for operations.
Claire, Middlesbrough

One does wonder about the real significance of these numbers. if those below the median are made to wait longer in order to reduce the median wait. You could quite easily get a reduction in median and in maximum but an increase in mean. An apparent reduction in waiting times actually would be an overall increase in man-days waited (albeit more fairly distributed). If you know what you're doing you can make statistics say anything.
Graham Spiller, Stevenage

I have several hospital appointments per year for an ongoing condition and have found that when I am given an appointment it is fairly quick so as to count towards these statistics. However almost all of these appointments are then cancelled and a further appointment made much further ahead which means I am waiting just as long as ever but probably deemed a success due to the first appointment made.
Andy Jamieson, Farnborough Hampshire

Of course, one other reason why waiting times have fallen is that if you have been on a waiting list for a long time you get a telephone call to ask whether they can remove you from the waiting list.... My relative had to insist several times that she wanted to remain on the list. She was clearly low priority and never received the pain-relieving treatment she was waiting for. However, she did move out of the catchment area for that hospital, so they succeeded in having her removed from the list eventually.
Kay Sanders, Huddersfield, UK

Waiting times are very deceptive. They dont take into account the time waiting to get on the waiting list
Philip Griffin, Milford Haven