Patients could be removed from the NHS waiting list if they refuse more than one date for their treatment, according to new internal guidance.
The tactic was branded an ‘appalling’ attempt to try to tackle the record backlog of 6.8million people who are waiting for routine hospital treatment.
Experts said NHS England, who issued the guidance, must ensure ‘patients do not feel bullied into moving off the waiting list’.
Patients who decline two proposed dates for treatment could be placed on ‘active monitoring’, away from the NHS’s main elective waiting list.
NHS England figures show 6.8million patients were in the queue for routine hospital treatment in July, equivalent to one in eight people. Nearly 380,000 have been waiting for over one 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 bullied into moving off the waiting list, and into active monitoring’
WHAT DO THE LATEST NHS PERFORMANCE FIGURES SHOW?
The overall waiting list jumped to 6.84million in July. This is up from 6.73million in June and is the highest number since records began in August 2007.
There were 2,885 people waiting more than two years to start treatment at the end of July, down from 3,861 in June but still higher than April 2021, when the figure started to be recorded.
The number of people waiting more than a year to start hospital treatment was 377,689, up from 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 for any month since record began in 2010.
A total of 130,528 people waited at least four hours from the decision to admit to admission in August, down slightly from the all-time high of 136,298 in March.
Just 71.4 per cent of patients were seen within four hours at A&Es last month, the second-worst ever performance. NHS standards set out that 95 per cent should be admitted, transferred or discharged within the four-hour window.
In August, the average category one response time – calls from people with life-threatening illnesses or injuries – was nine minutes and eight seconds. The target time 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. This is more than twice as long as the 18 minute target.
The guidance was seen by the Health Service Journal.
NHSE elective recovery adviser Sir Jim Mackey insisted the guidance was to support trusts to manage ‘a small number of patients who… continue to decline treatment date offers [and] to fill appointment slots so patients get seen as soon as possible’.
He said there were long-waiting patients who have refused ‘sometimes multiple offers’ of treatment, making ‘access for other patients more difficult when slots are held for them’.
‘The guidance stresses that there must be a clinical conversation with the patients before any decisions are taken about putting them on to active monitoring,’ he added.
In an accompanying document to the guidance, NHSE said trusts did not have to adopt the advice in full and suggested that patients would be able to reclaim their place in queue when appropriate.
Senior staff are concerned that poor record keeping of ‘active monitoring’ will mean patients will be lost once they are removed from the Referral To Treatment waiting list.
Waiting list consultant Rob Findlay said the guidance was an ‘abuse of national waiting times statistics’ and that ‘the menacing 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 bullied into moving off the waiting list, and into active monitoring.
‘NHSE will also need to ensure that trusts are not tempted to use the guidance to game waiting lists, making them appear shorter than they are in reality. This would do patients a huge disservice.
‘It may be wholly appropriate that a patient is moved to active monitoring, if they agree with that 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 streamlined picture of patients waiting for treatment, and patients a more realistic idea of how long their waits might be. Used poorly, it could see patients lost in the system, or banished to waiting list purgatory.’
NHSE said in a statement: ‘This guidance requested by individual trusts and agreed by DHSC [the Department of Health and Social Care] will mean the small number of patients who choose to delay their treatment will be given greater support and encouragement to proceed with 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 seen success, with almost 120,000 patients having been seen by their high street pharmacist in just one month, freeing up GPs to treat those who need them, according to new NHS figures.
In June 118,123 people with minor illnesses such as a sore throat or constipation, or or those in need of medicine urgently, received a same-day consultation with their local pharmacist after calling NHS 111 or their GP practice.
It is an increase of more than 80 per cent compared to the same month last year when the figure stood at 64,512.
NHSE also announced it was expanding roles for community pharmacies ahead of winter at its board meeting today.
From this week, NHS 111 online can directly refer people to their high street pharmacist for a same day consultation, rather than patients needing to call the phone line.