Why are we still waiting?

Why are we still waiting? Annual report on hospital waiting times The Patients Association June 2014 Contents Executive summary Page 1 1. 2. 3....
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Why are we still waiting?

Annual report on hospital waiting times The Patients Association

June 2014

Contents

Executive summary

Page 1

1. 2. 3. 4. 5. 6. 7.

Page 2 Page 6 Page 8 Page 9 Page 13 Page 16 Page 18

Introduction Policy background Methodology Results Case studies Discussion Conclusions and recommendations

8. References 9. Appendix

Page 19 Page 20

Executive summary The Patients Association has released its fourth annual report on hospital waiting times for surgical procedures in England, revealing inconsistent reporting by hospital trusts, unacceptable waiting times and poor patient experiences. The report highlights poor performance in the NHS and negative patient experiences and, once again, shows significant variations in waiting times across England, suggesting a ’postcode lottery’ when it comes to accessing healthcare. Long waiting times and cancelled operations continue to be an issue. Key findings Standards of reporting of waiting time data are poor across all regions:   

Just 54% of trusts responded within the statutory time period to the Freedom of Information request; The South of England had the worst response rate, at only 49%; There is considerable confusion amongst all regions regarding the recording and reporting of waiting time data. Many trusts provided data that was inconsistent, incorrect or missing entirely.

Waiting times for key surgical procedures have not improved:   

Waiting times for hernia and adenoid procedures have continued to rise across the country; A significant rise has been observed in the wait for tonsillectomy procedures (up to 79 days); Knee procedures continue to have the longest wait at 95 days;

Variations in waiting times exist across regions:  

The South of England region has the longest waiting times for cataract operations, with a mean average wait of 82 days, 13 days above the national average; London continues to have the longest wait for knee operations, with an average waiting time of 108 days.

Behind the facts and figures are real patients with real illnesses. Delays in surgery result in prolonged suffering for patients, especially older vulnerable people. Every extra day spent waiting for surgery is an extra day of pain and suffering. Patients need to be able to see for themselves which hospitals are performing well and which are not. This can only be achieved if hospitals adhere to strict reporting standards, are transparent, regularly audited and present information in a meaningful way to patients.

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1. Introduction The Patients Association is an independent national health and social care charity established over 50 years ago and has a long history of campaigning to ensure that the voice of patients is heard within the Health and Social care system. We achieve this through research, campaigns to support patients’ rights, lobbying Government to address healthcare issues affecting patients and speaking up for patients and carers. The Patients Association also provides an advisory national Helpline service to over 7000 patients each year who raise concerns about their experiences with healthcare providers. The nature of these enquiries cover issues such as poor care (particularly of elderly people in hospital), delayed or cancelled operations and problems with the complaints services. This offers us a wealth of information, with a database currently consisting of well over 40,000 cases, spanning many years and giving us a unique insight into the diverse nature of concerns raised by patients themselves. In order to make the best use of this information, the Patients Association provides data analysis and statistical research to detect emerging trends and patterns, and any concerns can be targeted towards improving patient care. Since 2010 the Patients Association has carried out an annual research project on hospital waiting times for surgical procedures across England. This year we continue to monitor the trends for 10 key procedures; hip, knee, hernia, adenoid, gallstone, tonsillectomy, myringotomies, varicose veins, carpal tunnel syndrome and cataract. This study was performed to determine whether there is a significant difference in the waiting times for these procedures compared to previous years, and to identify if there are regional differences in waiting times. NHS England is now divided up into 4 regional/area teams; North of England, Midlands and East of England, London and the South of England.

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North of England The North of England regional/area team covers Yorkshire and the Humber, the North-West and the North-East of England.

Source: NHS England (2014)

Midlands and East of England

Source: NHS England (2014)

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South of England The South Regional Team covers an area stretching from Penzance to Margate, serving a population of approximately 13.5 million people.

Source: NHS England (2014)

London The London regional/area team covers a population of 8.17 million people and commissions more than £15bn of services (Source: NHS England, 2014)

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By analysing data from these 4 regions, we can monitor waiting times that are susceptible to change as hospitals reorganise their budgets and governance structure to meet government targets, and highlight the presence of “postcode lotteries”. The research adds weight to the voice of patients who we represent, and holds the health providers and elected representatives to account.

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2. Policy background Since the foundation of the NHS in 1948 there has been an underlying ethos that good quality healthcare should be available to all, regardless of wealth or status. The system has always been based upon three core principles: that it meets the needs of everyone, that it be free at the point of delivery and that it be based on clinical need, not ability to pay However, the NHS is currently facing one of the most challenging times in its history. With an increasingly ageing population, the ever present need to modernise with new technologies, the prospect of a real-terms funding freeze and the Coalition Government efficiency savings demands of £20bn in the years 2011/12 to 2014/15, it is very likely that patients will ultimately be affected. The government however, repeatedly assures us that patient care will not suffer and that standards within the NHS will continue to be first-class. Given this assurance, it should therefore be assumed that the number of elective operations performed should not decrease significantly, nor should their waiting times increase from previous years. The NHS Constitution (NHS England, 2013) establishes the principles and values of the NHS in England; it sets out rights to which patients, public and staff are entitled. It also lays out pledges which the NHS is committed to achieve, together with responsibilities, which the public, patients and staff owe each other to ensure that the NHS operates fairly and effectively. The Secretary of State for Health, all NHS bodies, private and voluntary sector providers supplying NHS services, and local authorities in the exercise of their public health functions are required by law to take account of this Constitution in their decisions and actions. The NHS targets and pledges According to the NHS Constitution, patients have the right to access services within maximum waiting times. According to the Handbook to the NHS Constitution (which substantiates the document and explains the legal derivation of the rights and responsibilities), this right is supported by legislation dating back to April 2010. The right is for patients to “start their consultant-led treatment within a maximum of 18 weeks from referral for non-urgent conditions”; and to be “seen by a cancer specialist within a maximum of two weeks from GP referral for urgent referrals where cancer is suspected.” Where this is not possible, the appropriate commissioner of treatment must investigate and offer a range of suitable alternative providers. The Department of Health has furthered its commitment to waiting times with the consultation on strengthening the NHS Constitution. It sought to enforce the Constitution in a number of specific areas recommended by the NHS Future Forum working group. In their report the Government acknowledged the receipt of 357 consultation responses.

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The revised Constitution and updated Handbook were published on the 26 th March 2013. The revised documents re-state many of the existing waiting times pledges, including a maximum waiting time of four hours in A&E from arrival to admission (transfer or discharge), a requirement for Ambulance Trusts to respond to 75% of all Category A emergency calls within eight minutes and a target of 95% of all calls to be responded to within 19 minutes of a request being made. At the same time, new waiting times pledges have been included in the updated Handbook to the Constitution. For example, a “maximum one month (31-day) wait from diagnosis to first definitive treatment for all cancers”; a “maximum 62-day wait from referral from an NHS cancer screening service to first definitive treatment for cancer”; and a wait of less than 6 weeks from referral for patients waiting for a diagnostic test. Against the backdrop of waiting time targets and pledges is the need to balance the books. The NHS needs to be able to deliver high quality care to patients whilst doing so efficiently and without loss. The National Audit Office (NAO) estimate that in the year 2012 to 2013 there were 19.1 million referrals to hospital and as of August 2013 2.94 million people were waiting for treatment (NAO, 2014). However, the cost of elective care in the same period was £16 billion.

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3. Methodology Requests for information were sent out to 162 NHS trusts in England, under the Freedom of Information (FoI) Act 2000. Using our helpline research database, communications with clinicians and patients and based upon our previous research into this area, we identified ten key surgical procedures that are most likely to reflect the overall waiting time picture. The procedures were hip, knee, hernia, adenoid, gallstone, tonsillectomy, myringotomies, varicose veins, carpal tunnel syndrome and cataract. We included specialist trusts, such as paediatric, women’s and orthopaedic hospitals, as this was deemed an important indicator for changes in hip and knee surgery provision, as well as general trends. The questionnaires that were sent out to the trusts to gather the necessary data were designed in a clear table format so as to reduce the likelihood of errors and confusion (see appendix) in early March 2014 by email. The questions were: 1. Which Regional/Area Team does your hospital belong to? 2. Please set out the number of individual elective procedures that took place in your Trust in 2013 for the following categories – 3. Please set out the average waiting time (in days) within your trust, for each of the following procedures in 2013 – 4. Please set out the number of patients who waited for longer than 6 months, within your trust, for each of the following procedures in 2013 – (only include cases where clock was running)

A reminder email was sent out to all the trusts who had not responded within the statutory period of 20 working days. Several trusts had asked for clarification regarding which type of “waiting time” data we were requesting. A response email was sent clarifying that we were requesting data on Referral to Treatment (RTT) waiting time. Using the Patients Association’s comprehensive database, case studies were selected to highlight the impact that waiting times have upon the lives of real patients.

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4. Results A total of 162 requests for information were sent to NHS Trusts in England. A total of 92 responses was received, but 5 had to be rejected as they were returned after the project deadline.

Breakdown of responses across all NHS Trusts

3.10%

Responded

43.20% 53.70%

Did not respond Responded late

Fig.1: a comparison showing the breakdown of responses to the Patients Association questionnaire (n=162).

Breakdown of responses received by region Regional/Area Team

Response rate

North of England

33.33%

Midlands and East of England

22.99%

London

19.54%

South of England

24.14%

Table 1: Responses from the North of England accounted for a third of all responses; this is unsurprising as this region contains the largest number of Trusts (n=54).

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Comparison of the response rate within the four regions. Regional/Area Team

Response rate within region 53.70%

North of England Midlands and East of England

55.55%

London

58.62%

South of England

48.84%

Table 2: The London region returned the highest percentage of its questionnaires, with almost 60% of Trusts responding. The South of England region returned the lowest percentage, with only 49% of the Trusts in the region responding.

Mean average waiting time (in days) for 7 key surgical procedures

Hip Knee Hernia Cataract Tonsillectomy Adenoid Gallstone

2010 87.5 88.9 70.4 63.7 63.5 65.3 73.2

2011 93.8 99.2 78.3 65.9 64.7 64.1 80.6

2012 89.09 94.96 75.59 65.66 65.03 68.46 73.76

2013 91.15 94.82 80.66 68.77 78.6 79.23 73.12

Table 3

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Trends in waiting times over 4 years (hip, knee and cataract surgery) 120

Mean wait (days)

100

80

Hip

60

Knee Cataract

40

20

0 2010

2011

2012

2013

Year

Figure 2

Trends in waiting times over 4 years (hernia, tonsillectomy and adenoid surgery) 85

Mean wait (days)

80 75 70 Hernia 65

Tonsillectomy Adenoid

60 55 50 2010

2011

2012

2013

Year

Figure 3

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Regional comparison of waiting times for 4 key surgical procedures

120

Mean wait (days)

100 80 60 40 20 0 North of England Midlands and East of England London South of England

Hip 89.56 86.39 98.4 90.23

Knee 88.5 89.1 107.82 93.85

Hernia 83.11 77.8 79.52 82.19

Cataract 72.94 62.95 57.51 81.69

Figure 4

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5. Case studies

The Patients Association provides an advisory national Helpline service to over 7000 patients each year who raise concerns about their experiences with healthcare providers. The nature of these enquiries cover issues such as poor care (particularly of elderly people in hospital), delayed or cancelled operations and problems with the complaints services. This offers us a wealth of information, with a database currently consisting of well over 40,000 cases, spanning many years and giving us a unique insight into the diverse nature of concerns raised by patients themselves. Delayed and cancelled operations are highly inconvenient for patients; impacting upon their lives and that of the families. Patients will have often had to make childcare arrangements and re-arrange family commitments when they are expecting an operation (case study 1). For many patients, every extra day spent waiting for an operation can mean another day spent suffering in pain (case studies 2 and 3). . “In many cases the delay brings further deterioration, as does the prolonged anxiety. Anxiety is a cause of ill health. The NHS itself contributes to its rising costs.”

Case study 1 On Wednesday 14th May 2014 I received a letter from my hospital telling me that my long waited admission for bypass surgery had arrived. I should report to the hospital at 3pm on the next Sunday (5 days notice). My employer and I remade all of our plans for the next 6 weeks. We arranged cover for me (at a cost to my employer) and I prepared for the admission. As instructed, I rang to check that the bed was available, and was (not) surprised to be told that the op I have waited so long for was cancelled. Not because there is no bed but because there is no surgeon! No further appointment has been forthcoming to date, and it seems I may have lost the appointment that I had for 6th June as well. The worst thing is I have had no contact from the hospital at all except that the op is cancelled.

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Case study 2 Mrs. W was given an appointment date for early September 2013 for an operation on her right leg. Her son, as next of kin, received a telephone call on the morning before the admission day informing him that the operation had been cancelled, as the surgeon scheduled to carry out the operation was unable to perform it. She was referred back to the original consultant and the earliest date that the operation could be performed would be May 2014 as the consultant only worked alternate weeks at that hospital. I am painfully reminded every day that this operation needs to be done sooner rather than later and I am still being told that age is not taken into consideration when clinical decisions are made. I wonder if the doctor's appointments needed and the painkillers provided have cost more over the length of time involved than the hospital costs for a timely operation.

“I have been waiting since January, in considerable discomfort, for a hernia procedure.”

“I feel quite abandoned by the NHS”

Case study 3 In 2013 my 96 year old mother was seen by a consultant at the pain clinic, but spinal nerve injections were unsuccessful, and in July 2013 he referred her to a consultant neurosurgeon. It appears that the severe leg pain she is suffering is due to collapsing discs. In January 2014 she received a first appointment for February. A week before that appointment she received notification of cancellation and a new appointment for April. Again shortly prior to that appointment date it was again cancelled with a new date for June. On telephoning on her behalf to complain we got an appointment for May. That is some 40 weeks from referral. Meanwhile she has suffered constant pain which has had a major impact on her wellbeing and she has become increasingly housebound, thus placing an increasing burden on me. Increasing lack of mobility due to pain appears to be acerbating the condition or making her increasingly dwell on the pain. I should add that she lives independently on her own, without any care other than that provided by family i.e. help with shopping, gardening and transport. That level of independence will be substantially decreased if her pain is not dealt with and may result in her needing to go into a care home.

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We even hear from patients who have to resort to paying for private treatment out of frustration at NHS delays (case study 4). “I am resigned to the fact that very little NHS treatment appears to be carried out within an 18 month waiting period.”

“We are constantly being told to be more active but are hindered from doing so by such long delays”

Case study 4 In July 2012, Mrs. H saw a surgeon at her local hospital who said she needed an operation urgently, and referred her to a Pre-Operation Assessment Nurse, so that she would be ready immediately if a cancellation came up. Mrs. H felt that the pre-op assessment was incompetently handled, and that the nurse missed major health problems, which would have had an impact on the surgery. In October 2012, after hearing nothing about a date for an operation, Mrs. H phoned the hospital, only to be told that nothing was scheduled and probably wouldn't be until February 2013. After my experience with an incompetent pre-op assessment, and due to the delay, I was forced to go private. I had the operation five days after I had phoned up the surgeon's private secretary.

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6. Discussion Analysis by operation Since 2010, average waiting times for hernia, adenoid and tonsillectomy procedures have continued to rise across the country. The mean average wait for hernia procedures is now 81 days and the mean average wait for adenoid procedures is up to 79 days. A significant rise has also been observed in the waiting times for tonsillectomy procedures, up to 79 days. However, this must be seen in light of current best practice guidance regarding the criteria for surgery. For children, “watchful waiting” is now considered more appropriate than immediate surgery and for both adults and children with mild sore throats, surgery should only be considered when there have been seven or more well documented, clinically significant, adequately treated sore throats in the preceding year (NICE, 2012). It should also be noted that a Cochrane review found limited evidence of the benefit of tonsillectomy in adults (SIGN, 2010). It is quite possible therefore, that the increase in waiting times for this procedure are due to surgeons intentionally delaying surgical intervention in favour of trying other treatments first. Waiting times for hip, knee and cataract procedures have remained relatively constant (but still high) over the last year, with only small fluctuations in waiting times. Knee operations continue to have the longest waiting time delays at 95 days. Analysis by region The four most common surgical procedures (hip, knee, hernia and cataract) were grouped together and analysed by region. Across all of the four NHS regions, cataract procedures continue to have the lowest waiting time (69 days in 2013). The South of England has the longest waiting times for cataract operations, with the mean average wait being 82 days (13 days above the national average). The lowest waiting times are in London at 58 days (11 days below the national average). It is possible that an older population, and thus an increased number of patients in the South of England requiring cataract procedures, accounts for the longer waiting times observed. Conversely, London has a younger population and a greater density of hospitals (including specialist hospitals), thus meaning cataract operations are less common, and there are more hospitals to perform them when they are required. The London region and the South of England region have the highest waiting times for knee procedures, with a mean average waiting time of 108 days and 94 days respectively. Waiting times for hernia and hip procedures were relatively universal for all regions.

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Reporting inconsistencies It became quickly apparent that obtaining the relevant data from the 162 trusts was likely to be a challenge. After the statutory 20 day period in which the trusts are obliged to respond, only around a quarter had done so. Even after a further 20-day extension was granted, just 57% of trusts replied to the questionnaire. The South of England regional area had the lowest proportion of returned requests, with only 49% of trusts responding at all. London returned the highest number at 59%. Responses from the North of England accounted for a third of all responses; this is unsurprising as this region contains the largest number of Trusts (54 in total). Furthermore, it was very unfortunate that many trusts did not provide data in response to all of the questions asked. In some cases an explanation for the missing data was provided. Many trusts informed us that revealing the data on procedures that are only carried out in small numbers may reveal an individual patients identity, and thus preventing them from providing the information. However, it was also noticed that some trusts provided data in the wrong format, there were many data entry/typing errors and some of the data was inconsistent with what would have been expected. Several trusts had asked for clarification regarding which type of “waiting time” data we were requesting. A response email was sent clarifying that we were requesting data on Referral to Treatment (RTT) waiting time. However, even after this, around 25 trusts were still unable to provide data for RTT waits and some provided data using other measures. The National Audit Office (NAO) has also highlighted inconsistencies in the way trusts measure waiting times, and errors in the way that waiting times are recorded and reported. Their report NHS waiting times for elective care in England (NAO, 2014) was published in January 2014 and found that although the rules for applying the waiting times standards are set at a national level, the performances of individual trusts are not directly comparable owing to local variations in how and when each patient’s waiting time ‘clock’ is started, paused or stopped.

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7. Conclusions and recommendations This report has highlighted one of the most important challenges for the NHS; that of accurately recording, collating and reporting waiting time data. This has direct and major implications for patients. It is based upon this data that funding is allocated and resources apportioned. If NHS England is to be in a position where it can properly manage and plan its services across its four regions, there will have to be dramatic changes to the collection and reporting of waiting time data. Without the assurance that performance data is correct, it is not possible to carry out meaningful strategic needs assessments. This makes it impossible to correctly and efficiently allocate funding to target specific issues in specific areas. It would therefore be prudent to ensure that NHS England adopts a checking system to ensure that the data being provided by individual trusts is accurate and can be relied upon. Patients and the public expect the NHS to be open and transparent. To maintain public confidence and trust in the system, there must be accurate recording and reporting of waiting time data. Our report highlights that patients today are still waiting far too long for surgical procedures. Furthermore, there has been almost no improvement over the last 4 years for any key procedure. Indeed, waiting times for hernia, tonsillectomy and adenoid procedures have got worse. Whilst waiting times for hip, knee and cataract procedures have remained relatively constant, there hasn’t been any reduction. Behind the facts and figures are real patients with real lives. We must remember that delayed and cancelled operations have a major impact upon the lives of vulnerable patients. Every extra day a patients spends waiting for a knee or a hip replacement, is an extra day spent in pain. For older patients, delays in surgery can result in prolonged periods of immobility, which can have profound effects upon their ability to socialise and integrate into their communities. The NHS continues to face one of its most challenging periods in its 66-year history. It is clear today that we have an increasingly ageing population, which is increasingly suffering from multiple health and social care problems. In addition, patient demands and expectations of healthcare have increased dramatically in recent years and the NHS is struggling to cope. The NHS is founded on the principle that good quality healthcare should be available to all, regardless of wealth or status and that it is free at the point of delivery. Policy makers have to find a way of balancing this increased demand and expectation with reduced budgets and cut-backs, and the need to improve efficiency. However, it must be remembered that it is the individual patient who is at the centre of healthcare, and it is ultimately the patient who suffers when policy goes wrong.

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8. References National Audit Office (2014) NHS waiting times for elective care in England. Available at: http://www.nao.org.uk/press-releases/nhs-waiting-times-elective-careengland/ (Accessed: 9th May 2014) National Institute for Health and Care Excellence (2012) Tonsillectomy. Available at: http://cks.nice.org.uk/sore-throat-acute#!supportingevidence1:12 (Accessed: 2nd June 2014) NHS Choices (2013) The NHS Constitution. Available at: http://www.nhs.uk/choiceintheNHS/Rightsandpledges/NHSConstitution/Pages/Overvi ew.aspx (Accessed: 6th May 2014) NHS England (2014) Regional & area teams. Available at: http://www.england.nhs.uk/about/regional-area-teams/ (Accessed: 27th May 2014) Scottish Intercollegiate Guidelines Network (2010) Management of sore throat and indications for tonsillectomy: a national clinical guideline. Available at: www.sign.ac.uk (Accessed: 2nd June 2014).

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9. Appendix

Information on waiting times for elective surgery (Freedom of information request) Dear Sir/Madam, The Patients Association is a national independent health and social care charity which listens to the experiences of patients and speaks up for change. We continue to hear via our Helpline and through our own research that there are regional variations in waiting times for certain elective surgical procedures. We have undertaken this exercise over the previous four years and continue to monitor the situation. In response to this we are carrying out a report into the waiting times for 10 standard procedures across NHS trusts in England. These procedures are: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10.

Hip Knee Hernia Adenoid Gallstone Tonsillectomy Myringotomies Varicose veins Carpal tunnel syndrome Cataract

We understand that you are very busy but would really appreciate it if you would make every effort to complete this short survey. I would like to obtain this information under a Freedom of Information Act 2000 Request, and would be grateful if you could respond within the statutory period of 20 working days. We look forward to hearing from you. Yours sincerely,

Katherine Murphy Chief Executive The Patients Association

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1. Which Regional/Area Team does your hospital belong to? Please tick ONE of the following 4 options:

North of England Midlands and East of England London South of England

2. Please set out the number of individual elective procedures that took place in your Trust in 2013 for the following categories –

I.

Hip replacement

II.

Knee replacements

III.

Hernia Operations

IV.

Adenoid Operations

V.

Gallstone operations

VI.

Tonsillectomies

VII.

Myringotomies

VIII.

Varicose veins

IX. X.

Carpal tunnel syndrome

Cataract operations

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3. Please set out the average waiting time (in days), within your trust, for each of the following procedures in 2013 –

I.

Hip replacements

II.

Knee replacements

III.

Hernia Operations

IV.

Adenoid Operations

V.

Gallstone operations

VI.

Tonsillectomies

VII.

Myringotomies

VIII.

Varicose veins

IX. X.

Carpal tunnel syndrome

Cataract operations

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4. Please set out the number of patients who waited for longer than 6 months, within your trust, for each of the following procedures in 2013 – (Only include cases where clock was running)

i.

Hip replacements

ii.

Knee replacements

iii.

Hernia Operations

iv.

Adenoid Operations

v.

Gallstone operations

vi.

Tonsillectomies

vii.

Myringotomies

viii.

Varicose veins

ix. x.

Carpal tunnel syndrome

Cataract operations

Please send your responses, within the statutory response time to: [email protected] or post your response to: The Patients Association, PO Box 935, Harrow, Middlesex, HA1 3YJ. Office tel: 020 8423 9111

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Top 3 performing Trusts for each procedure All data has been provided directly by each hospital Trust in response to the Freedom of Information request. Only 54% of Trusts responded to the Freedom of Information request.

Hospital Trust

Hip replacements

Knee replacements

Hernia

Adenoid

Gallstone

Number of procedures carried out

Average waiting time (in days)

Barts Health NHS Trust

174

47

Barnsley Hospital NHS Foundation Trust

197

50

Lancashire Teaching Hospitals NHS Foundation Trust

337

55

Barnsley Hospital NHS Foundation Trust

436

50

Barts Health NHS Trust

186

53

Lancashire Teaching Hospitals NHS Foundation Trust

340

61

Barts Health NHS Trust

637

30

The Mid Yorkshire Hospitals NHS Trust

1074

42

Croydon Health Services NHS Trust

715

43

The Rotherham NHS Foundation Trust

88

31

Bedford Hospital NHS Trust

7

35

Barts Health NHS Trust

455

41

Sheffield Teaching Hospitals NHS Foundation Trust

23

41

Mid Staffordshire NHS Foundation Trust

30

10

Barts Health NHS Trust

379

24

1

26

Portsmouth Hospitals NHS Trust

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Tonsillectomy

The Rotherham NHS Foundation Trust

7

11

277

35

562

41

The Rotherham NHS Foundation Trust

189

30

Bedford Hospital NHS Trust

145

38

Barts Health NHS Trust

275

41

Northern Devon Healthcare NHS Trust

149

41

Nottingham University Hospitals NHS Trust

4

23

Northern Lincolnshire and Goole NHS Foundation Trust

8

34

Bedford Hospital NHS Trust

124

40

Nottingham University Hospitals NHS Trust

138

3

University Hospitals of Leicester NHS Trust

503

26

Frimley Park Hospital NHS Trust

344

37

Barnet and Chase Farm Hospitals

1262

6

Barts Health NHS Trust

692

23

The Rotherham NHS Foundation Trust

1653

24

Frimley Park Hospital NHS Trust Barts Health NHS Trust

Myringotomies

Varicose veins

Carpal tunnel syndrome

Cataract

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Bottom 3 performing Trusts for each procedure All data has been provided directly by each hospital Trust in response to the Freedom of Information request. Only 54% of Trusts responded to the Freedom of Information request.

Hospital Trust

Hip replacements

Knee replacements

Hernia

Adenoid

Gallstone

Number of procedures carried out

Average waiting time (in days)

Barnet and Chase Farm Hospitals

267

191

West Middlesex University Hospital NHS Trust

82

160

North Cumbria University Hospitals NHS Trust

348

154

Barnet and Chase Farm Hospitals

370

215

Imperial College Healthcare NHS Trust

241

164

North Cumbria University Hospitals NHS Trust

362

137

Royal Liverpool and Broadgreen University Hospitals NHS Trust

451

129

Maidstone & Tunbridge Wells NHS Trust

711

124

The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust

606

118

Royal Free London NHS Foundation Trust

5

147

The Shrewsbury and Telford Hospital NHS Trust

17

129

Imperial College Healthcare NHS Trust

223

127

Sheffield Teaching Hospitals NHS Foundation Trust

862

160

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Tonsillectomy

Myringotomies

Varicose veins

Carpal tunnel syndrome

Cataract

The Royal Wolverhampton NHS Trust

415

122

Maidstone & Tunbridge Wells NHS Trust

541

118

Barnet and Chase Farm Hospitals

429

153

Chelsea and Westminster Healthcare NHS Foundation Trust

206

135

University Hospital of North Staffordshire NHS Trust

406

130

The Whittington Hospital NHS Trust

34

130

University Hospital of North Staffordshire NHS Trust

192

118

Frimley Park Hospital NHS Foundation Trust

209

111

Barnet and Chase Farm Hospitals

134

137

Warrington and Halton Hospitals NHS Foundation Trust

300

133

Lancashire Teaching Hospitals NHS Foundation Trust

317

130

West Hertfordshire Hospitals NHS Trust

304

192

The Robert Jones & Agnes Hunt Orthopaedic Hospital NHS Foundation Trust

390

118

York Teaching Hospitals NHS Foundation Trust

252

116

Sheffield Teaching Hospitals NHS Foundation Trust

3988

161

Royal Berkshire NHS Foundation Trust

3995

124

34

122

Chelsea and Westminster Healthcare NHS Foundation Trust

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