The NHS long wait



Hidden waiting lists for NHS treatment, revealed for the first time, indicate that patients wait an average of seven weeks for diagnostic tests. Until now the Government has measured only how long patients wait for their first consultant appointment and then for treatment. Waits for vital diagnostic tests have been ignored.

The promise that all patients will be treated within 18 weeks of referral by a family doctor has obliged the Department of Health to start measuring these diagnostic waits. The results indicated large variations by area and by test - but also that the ambitious 18-week target was achievable, Andy Burnham, a Health minister, said yesterday.

About half of patients were being seen within the target time, officials said, but less than 1 per cent were waiting more than two years. Three quarters of tests are carried out within 13 weeks, the interim target the NHS is aiming for across the service by April 2007.

By April 2008 the target will be six weeks and by the end of that year the entire "patient journey" should be no more than 18 weeks. A small minority is expected to experience longer waits, either for clinical reasons or out of choice. But the department has yet to decide how much "wriggle room" to allow for these patients.

Every month the NHS does 50 million tests. Of the 15 key tests for which waits were measured, slightly more than 200,000 were taking more than 13 weeks to complete. A census of trusts that looked at 500 less common tests found roughly another 250,000 of these were taking more than 13 weeks. That means that, at present, 450,000 tests are taking longer than the target set for next April. This is not a large proportion of the total number of tests done, making next April's target look achievable.

The department's calculations of average waits indicate that the longest are for hearing tests, with colonoscopy taking almost as long. But the department also published data suggesting that waits for MRI and CT scans had fallen sharply since October 2005, when choice was introduced for patients who did not have a scan scheduled within the next 20 weeks.

The data indicate that allowing patients to choose where to go for their scans has cut the number waiting longer than 26 weeks from almost 16 per cent to less than 1 per cent. Andrew Lansley, the Shadow Health Secretary, said that the figures did not give the whole story.

"We know that some patients are forced to wait longer than 26 weeks, but we do not know the maximum wait," he said. "Some patients are waiting longer than two years for crucial diagnostic tests. Any significant wait for diagnosis is unacceptable. It would be an entirely alien concept to a patient in France, Germany, the United States and many other countries that they should have to wait for any diagnostic tests. It should be the same here."

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Australia: Mammogram incompetence in Queensland's socialized medicine system

There are increasing concerns about Queensland Health's breast cancer screening service after it emerged yesterday that 9300 women's mammograms had to be reviewed last year. The review was ordered after three of the five radiologists contracted to BreastScreen in Cairns failed to detect the expected number of small cancers in the 2004-2005 financial year. All films taken during that year were checked in the review, which took the service's most experienced radiologist almost five months to complete.

From the checks, 83 women were recalled to repeat their tests and two were found to have ductual carcinoma in situ, a non-invasive form of breast cancer. Two Gold Coast women this week launched legal action against Queensland Health alleging negligence after their aggressive cancers were not detected from their mammograms.

Opposition health spokesman Bruce Flegg accused the Government of a cover-up for not publicly announcing the review, but the Government asserted the review showed quality assurance processes were working. Queensland Health senior director of cancer screening services Jennifer Muller said the review was part of the normal quality control processes. "It's not an unusual event that we would want to do a review because we're committed to providing a high quality service," Ms Muller said.

Health Minister Stephen Robertson said BreastScreen was continually undertaking quality control measures, which led to the "exhaustive review" of the Cairns service. "No service is perfect but when you consider the number of women now using the service throughout Australia we will provide a world-class service," he said. "What we've seen over the last couple of days is experts from that service coming out and saying that we provide a service that identifies nine out of 10 cancers - it's not perfect. "The important thing is when we find problems or the service hasn't met appropriate standards . . . we fix it, and that's what we've done in the Cairns case."

But Dr Flegg accused the Minister of a cavalier approach to public health. "I think it raises some pretty serious issues when they knew there was a quality problem with readings in Cairns," he said.. "I think it does cast a doubt in the minds of patients as to how reliable the reading at BreastScreen Queensland is."

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For greatest efficiency, lowest cost and maximum choice, ALL hospitals and health insurance schemes should be privately owned and run -- with government-paid vouchers for the very poor and minimal regulation. Both Australia and Sweden have large private sector health systems with government reimbursement for privately-provided services so can a purely private system with some level of government reimbursement or insurance for the poor be so hard to do?

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