The time it takes for a patient to be seen or treated by a particular service or health practitioner is often used, alongside other metrics, as one measure of quality of care. Different teams and organisations across the health and social care sector are responsible for achieving different waiting time targets. However, patient waiting times across those different services often correlate, and improvements to waiting times in one service are often related to, or dependent on, improvements to waiting times in another service.
Long patient waiting times are often linked
Commonly measured patient waiting times in the NHS include waiting times to be seen by an ambulance; to be seen by an accident and emergency (A&E) clinician; to access a diagnostic service; to have an elective procedure; or to access a cancer treatment. If waiting times deteriorate in one service, it is common for waiting times in other services to also deteriorate; for example, during months when waiting times for ambulances are long, there are often also long waiting times in A&E.
Common pressures across the health and care system
One possible reason for this co-ordinated deterioration is that the health and social care system is facing a common pressure. This could be due to a spike in demand for services (eg, Covid-19 infections), a lack of resources (eg, staff shortages), or a disruption to a common service (eg, IT system failures). The NHS is currently struggling to maintain waiting time performance due to a range of these common pressures.
Interdependence between health services
Co-ordinated deterioration in patient waiting times is also caused by the interdependencies between different parts of the health service. Long waiting times in one part of a patient pathway can have a knock-on effect on the rest of the pathway; for example, when social care capacity is full, patients wait longer to be discharged from a hospital bed. When hospital bed capacity is full, patients wait longer in A&E for a hospital bed. When A&E capacity is full, patients wait longer in an ambulance to be ‘handed over'. And when handover times are long, patients in the community wait longer for an ambulance to respond to their 999 calls. This can cause aggregate waiting times across an emergency pathway to rise rapidly.
Interdependencies across the health and care system
These interdependencies also extend to other hospital services, such as elective procedures, and to waits for other types of care, such as social care and primary care. This means that to reduce waiting time in one area of the system, waiting times in the other areas also need to be taken into consideration. Solutions to long waiting times need to consider patient pathways and health and social care systems as a whole.