There's strong evidence of a 'threshold effect' in English hospitals' efforts to comply with the 18-week referral to treatment standard, concludes a long term data analysis of performance against the target, published online in the journal BMJ Quality & Safety.
There's strong evidence of a 'threshold effect' in English hospitals' efforts to comply with the 18-week referral to treatment standard, concludes a long term data analysis of performance against the target, published online in the journalThe target focused activity on meeting the threshold requirement for patients on the waiting list after which it tailed off—the so-called threshold effect–rather than instigating pervasive improvement in practice, the analysis indicates.
They analyzed waiting times for all patients and then repeated this for 13 specific treatment groups: cardiology; cardiothoracic; dermatology; ear, nose and throat; gastroenterology;; gynecology; neurosurgery; ophthalmology; oral surgery; plastic surgery; trauma and orthopedics; and urology. Similarly, the percentage of trusts where patients waited less than 18 weeks fell gradually after the removal in 2016–17 of the financial sanction for breaching the standard. It then fell sharply during the early phase of COVID-19 in 2020–21 before gradually recovering.
The threshold effect only disappeared in the financial years 2020–21 and 2021–22, when the COVID-19 pandemic made it virtually impossible for most hospitals to meet the target. Nevertheless, they conclude,"Our findings suggest that hospital trusts may choose whom to treat based on the target instead of clinical need, as the target provides no encouragement to treat patients who have only been waiting for a short time or who have already passed the 18-week wait."
"However, if there are insufficient resources—for example, in the case of waiting lists where demand exceeds capacity, or the organization lacks the skills and resources to undertake a major review of processes and ways of working—less desirable approaches may be taken."
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