NHS maximum waiting time standards

The NHS Constitution for England provides that patients have the right to access certain services commissioned by the NHS within maximum waiting times, or for the NHS to offer suitable alternatives if this is not possible. The waiting times – provided either as patient rights or pledges - are described in the accompanying Handbook to the NHS Constitution for England (last updated October 2019).

Patients currently have a right to the following maximum waiting times:

• 18 weeks from referral to consultant-led treatment (for 95% of patients);
• Two weeks to see a specialist for urgent cancer referrals (for 93% of patients).

There are additional pledges on waiting times, including a maximum waiting time of:

• 4 hours in A&E target;
• Four weeks for children and young people with an eating disorder (and one week for urgent cases);
• Six weeks between referral and first treatment for IAPT (Increasing Access to Psychological Therapies) for 75% of patients, and 18 weeks for 95% of patients;
• Two weeks for access to early intervention care for people experiencing a first episode of psychosis;
• One month wait from diagnosis to treatment for all cancers.

The full list of waiting time standards is provided in section 1 of the briefing.

Commissioners are responsible for enforcing waiting time standards through contracts with service providers, mostly NHS Trusts. This is primarily through CCGs commissioning services using the NHS Standard Contract. Concerns have been raised that financial sanctions have been gradually removed from the Standard Contract for waiting time standards, including the 18-week referral to treatment (RTT) and cancer standards.

In April 2019, NHS England introduced a new fine for providers and commissioners to each pay £2,500 per patient that exceeds a 52-week waiting time from referral to treatment.

NHS England is currently undertaking a Clinically-led Review of NHS Access Standards. The interim report was published in March 2019 and sets out initial proposals to changes for waiting times, in mental health services, cancer care, elective care and urgent and emergency care. A brief summary of the proposed changes is provided below,

• The 18-week RTT target for 95% of patients would either be amended by reviewing the maximum number of weeks and percentage threshold, or by introducing an average wait target.
• The number of cancer waiting time targets would be reduced from ten to three, including a maximum 28 day wait from GP referral to definite diagnosis, or exclusion, of cancer.
• For mental health, the review proposes reducing the length of time for patients to access treatment in mental health crisis and a four-week waiting time for children and young people, and adult community mental health services.
• For A&E, the review proposes introducing target for waiting time to initial clinical assessment, time to emergency treatment for critical cases, time spent overall in A&E, and hospitals use of Same Day Emergency Care.

The NHS is currently trialling the proposals, and will publish a public consultation, due in “early 2020”. Implementation of the new standards is expected in 2020/21.

Covid-19 changes

It was announced in March 2020 that all NHS non-urgent operations in England will be postponed.[1] NHS England and NHS Improvement have said that providers will need to postpone all non-urgent elective operations from 15th April at the latest, for a period of at least three months.[2]

However, Trusts’ performance against waiting time targets will continue to be monitored during this period. A letter from NHS England and NHS Improvement in March 2020 confirmed that monitoring and management of standards such as the four-hour accident and emergency wait and 18-week elective care referral to treatment (RTT) targets will continue.

Fines for breaches of the 52-week RTT target will be suspended from 1 April onwards, and the 28-day faster diagnosis standard for cancer will not be subject to formal performance management.[3]

[1] Department for Health and Social Care (DHSC), Coronavirus Bill Summary of Impacts, 19 March 2020, page 5

[2] NHS England and NHS Improvement, Letter to Chief executives of all NHS trusts and foundation trusts

, CCG Accountable Officers, GP practices and Primary Care Networks, Providers of community health services, 17 March 2020

[3] Health Service Journal, Trusts will still be monitored on A&E targets during covid-19 crisis, 30 March 2020