Search tips
Search criteria 


Logo of bmjThis ArticleThe BMJ
BMJ. 2007 July 14; 335(7610): 64.
PMCID: PMC1914506

Orthopaedic departments will have more difficulty meeting 18 week waiting target

Experts have highlighted considerable hurdles facing the NHS as it prepares to meet the government's 2008 deadline for eliminating waiting times of more than 18 weeks.

Last month, the then health minister Andy Burnham said that long delays between referral by a GP and hospital treatment would be banished for good, with no one waiting more than 18 weeks, by December next year.

He said, “This is in my view the end of waiting. I think this represents the culmination of our 10 year programme.”

At a meeting of clinicians and Department of Health civil servants last week, however, warnings were sounded about poor progress in several areas.

Sue Hill, the department's chief scientific officer, admitted that the situation for audiology services was “pretty dire,” with some patients waiting more than 50 weeks.

The gynaecologist Clive Pickles, from the Sherwood Forest Hospital NHS Trust, said that organisation within his department had been “a complete and utter shambles,” with a lack of interest from clinicians and managers.

He added that only when it had become an official Department of Health pilot site for testing new systems for implementing the 18 weeks pledge had senior staff shown any interest.

He said, “Unless you get the chief executive at the top saying this is going to happen, then you won't make any progress.”

He added that in the process he had uncovered nine month waiting times for urodynamics tests and physiotherapy.

Speakers at the meeting, a practical guide to delivering the 18 week patient pathway,” noted that trusts have only until the end of November this year to ensure that plans are in place for delivering maximum waits of 18 weeks.

As evidence of progress, the government has cited figures showing that in March this year just under half of all patients were already receiving their first hospital treatment within 18 months of referral by a GP (BMJ 2007;334:1243, 16 Jun doi: 10.1136/bmj.39241.674595.DB).

The figures also showed, though, that one patient in eight was still waiting more than a year for treatment.

Of all specialties, orthopaedics accounts for the most operations, and experts at the meeting, organised by Healthcare Events, expressed concern about the scale of the problem facing this specialty.

Ian Bayley, a consultant surgeon at the Royal National Orthopaedic Hospital, in Stanmore, Middlesex, noted that less than 25% of orthopaedic patients were currently admitted within 18 weeks.

Hospitals had already made significant changes to their operating systems, he said, however, and for further progress to meet the December 2008 deadline, primary care organisations would also have to cooperate with acute trusts by reducing unnecessary referrals.

“We won't make 18 weeks unless we bring these people on board,” he said.

Professor Hill added that better organisation throughout the NHS would also be necessary. “Many people are collecting their data in shoe boxes that are kept under their desks,” she said.

She added that improving referral criteria, confirming appointments by telephone to make attendance better, provision of diagnostics in primary care, and group instruction sessions would make the 18 week target easier to hit.

Articles from The BMJ are provided here courtesy of BMJ Publishing Group