Waiting times have become the standard against which the performance of the NHS and social care service are measured. The reality is, however, that without meaningful change, they are likely only to become longer. Even if they improved, would that necessarily mean we had a properly functioning health service or that patients received a better standard of care?
Has the time come to abandon waiting times as a yardstick of success and instead to focus on more meaningful metrics, including those that can bring about change? Most public angst is reserved for waiting times at A&E departments because they are the gateway through which most patients enter the system.
But the King’s Fund think tank has pointed out that even measuring the proportion of patients seen within the four-hour target is problematic. Other metrics may be more accurate in measuring quality of care, such as the time patients wait before being clinically assessed or how long critically ill patients wait before their treatment is completed.
Waiting-time statistics don’t show how often someone turns up with a minor complaint that is masking something more serious and subsequently detected by a diligent clinician. Acute, emergency care may be seen as the sharp end of the health service, but fewer people die from falling over when drunk than from heart disease, cancers and strokes, which take more time to treat and rely on expensive, time-consuming, long-term testing.
At the heart of the dilemma is the question of where best to distribute scarce resources. We have too many patients with too few resources and our options are therefore to reduce the number of patients or to increase resources, and the latter is not currently viable. Fewer patients would enter the system if more paid for their treatment privately.
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In the Republic of Ireland, a GP appointment costs about €60 — with exemptions for pensioners, children under six and people on low incomes. Patients are also charged if they visit an emergency department without a GP’s referral. The Irish system may be unpopular among some, but it stops people turning up because they need paracetamol.
The NHS was devised in the late 1940s and, while it has been revised, many of us are still treated by a system that would be familiar to patients in the 1950s. How it will change in the next few years — if it changes at all — will depend upon public tolerance of a steadily worsening service. In the meantime, we will all have to wait and see.
Ivor Campbell is managing director of Snedden Campbell, a search company for the medical technology industry
