Patients could be removed from the NHS waiting list if they refuse more than one date for their treatment, according to new internal guidelines.
The tactic has been called an ‘appalling’ attempt to tackle the record backlog of 6.8 million people awaiting routine hospital treatment.
Experts said NHS England, which issued the guidelines, must ensure “patients don’t feel intimidated into coming off the waiting list”.
Patients who refuse two proposed dates for treatment could be placed on ‘active surveillance’, away from the main NHS elective waiting list.
Figures from NHS England show 6.8 million patients were in the queue for routine hospital treatment in July, equivalent to one in eight people. Nearly 380,000 have been waiting for more than a year
Neil Mortensen, president of the Royal College of Surgeons of England, said: ‘NHS trusts and clinicians will need to ensure that patients do not feel intimidated into coming off the waiting list and into active monitoring’
WHAT DO THE LATEST NHS PERFORMANCE FIGURES SHOW?
The global waiting list jumped to 6.84 million in July. This is up from 6.73 million in June and is the highest number since records began in August 2007.
There were 2,885 people wait more than two years start treatment at the end of July, compared to 3,861 in June but still higher than in April 2021, when the figure began to be recorded.
The number of people wait more than a year to start hospital treatment was 377,689, compared to 355,774 the previous month.
Some 28,756 people had to wait more than 12 hours in A&E departments in England in August. The figure is down from 29,317 in July, but is the second highest of any month since the record began in 2010.
A total of 130,528 people waited at least four hours decision to admit in August, down slightly from the all-time high of 136,298 in March.
Only 71.4% of patients were seen within four hours at the A&Es last month, the second-worst performance ever. NHS standards state that 95% must be admitted, transferred or discharged within the four-hour window.
In August, the average category 1 response time – calls from people with life-threatening illnesses or injuries – lasted nine minutes and eight seconds. The time allotted is seven minutes.
Ambulances took an average of 42 minutes and 44 seconds to respond to category two calls, such as burns, epilepsy and strokes. That’s more than twice as long as the 18-minute target.
The advice was seen by the Health Service Journal.
NHSE elective recovery adviser Sir Jim Mackey insisted the advice was to support trusts to manage “a small number of patients who…continue to refuse treatment date offers [and] to fill appointment slots so that patients are seen as soon as possible”.
He said there were patients on long waits who refused “sometimes multiple offers” of treatment, making it “more difficult for other patients to access when slots are reserved for them”.
“The guidelines emphasize that there should be a clinical conversation with patients before any decision is made about placing them on active surveillance,” he added.
In a document accompanying the guidance, the NHSE said trusts did not have to adopt the advice in full and suggested patients could reclaim their place in the queue if appropriate.
Senior managers are concerned that poor “active surveillance” record keeping will mean that patients will be lost once they are removed from the treatment referral waiting list.
Waiting list consultant Rob Findlay said the advice was an “abuse of national wait time statistics” and that “the threat of patients [proposed in the strategies outlined in the guidance] is appalling”.
Neil Mortensen, president of the Royal College of Surgeons of England, said: “NHS trusts and clinicians will need to ensure that patients do not feel intimidated into coming off the waiting list and into active monitoring.
“NHSE will also need to ensure that trusts are not tempted to use advice to game waiting lists, making them appear shorter than they actually are. That would do patients a huge disservice.
“It may be entirely appropriate for a patient to be moved to active surveillance, if they agree with this approach.
“But, will NHS systems be able to cope with moving patients on and off waiting lists?”
He added: “Used responsibly, these new guidelines could give us a more simplified picture of patients waiting for treatment and patients a more realistic idea of how long they will be waiting. Misused, it could see patients lost in the system or sent back to purgatory on a waiting list.
NHSE said in a statement: “This advice requested by individual trusts and accepted by DHSC [the Department of Health and Social Care] will mean that the small number of patients who choose to delay their treatment will have greater support and encouragement to pursue the care they need – this is clinically better for patients and reduces the administrative burden on staff.
Meanwhile, NHSE efforts to reduce pressures in primary care have been successful, with nearly 120,000 patients seen by their street pharmacist in just one month, freeing up GPs to treat those in need. need, according to new NHS figures.
In June, 118,123 people with minor ailments such as a sore throat or constipation, or in urgent need of medication, received a same-day consultation with their local pharmacist after calling NHS 111 or their general practitioner’s office.
This is an increase of more than 80% compared to the same month last year when the figure stood at 64,512.
The NHSE also announced it is expanding the roles of community pharmacies ahead of winter at its board meeting today.
From this week, NHS 111 online can refer people directly to their street pharmacist for a same-day consultation, rather than patients needing to ring the phone line.