5 Waiting times
77. As we noted earlier, one of the areas in which
health policy in England and Wales has diverged is in the targets
set for waiting times. In England, the maximum waiting time target
is 18 weeks from referral to start of treatment. In Wales, there
is a longer maximum waiting time target of 26 weeks from referral
to start of treatment.
78. In addition, different arrangements apply to
the treatment of patients from across the border in England and
Wales. Welsh providers are required to work to the standards and
targets set out by the Welsh Government for all patients whom
they see and treat, whether they are patients registered in Wales
or patients treated in Wales from any other part of the UK. English
providers are required to work to the standards and targets set
out by the Department of Health for patients who are the responsibility
of English commissioners. Services accessed in England by patients
registered in Wales are commissioned by Welsh commissioners to
meet Welsh Government performance targets.
Dealing with different targets
79. Witnesses told us that the existence of different
waiting time targets in the Welsh and English NHS caused significant
problems for clinicians, administrators and ultimately patients.[67]
80. The BMA told us that longer waiting times caused
problems to Welsh GPs and their workload:
We are having to see those patients more regularly;
we are writing expedite letters on a daily basis, which takes
up GP and secretarial time. From time to time, patients ask 'Were
I an English resident registered with an English GP, would the
wait be different?[68]
81. A number of English providers referred to the
additional administrative burden of differentiating between waiting
times as an area of difficulty. Shropshire Clinical Commissioning
Group highlighted the difficulties of treating Welsh patients
in line with Welsh targets:
In reality this means […] English hospitals
on the border are running with two sets of targets English and
Welsh. This can lead to communication issues with patients as
some consultants have said directly to them that Welsh patients
aren't managed to the same targets because they as a provider
are not paid to do so.[69]
82. Anecdotal evidence we received from patients
showed that it was possible for a Welsh patient to wait longer
for treatment at an English hospital than an English patient with
a similar complaint, due to the difference in waiting time targets
between the two administrations.[70]
The BMA stated that this did not "sit easily" with clinicians.[71]
83. It is important to note that this difference
only affects elective treatment. There was no suggestion that
Wales-registered patients would ever wait longer than English-registered
patients for clinically urgent treatments. However, the Committee
received representation that the differential in waiting times
was unfair. Powys Teaching Health Board commented that patients
saw waiting times as a 'two-tier service' where there was a level
of guarantee that treatment would be sooner for English patients
treated in England.[72]
84. Patients argued that they were paying the same
taxes, irrespective of which side of the border they lived, and
should therefore be treated equally. The BMA called for waiting
time standards to be the same on both sides of the border:
We treat people in the same way, so it would
be helpful to us to have things the same. To have two different
standards when you are doing one thing is not that helpful ...[73]
85. Jane Ellison told us that hospitals in England
were acting to targets set by the Welsh Government, and that they
were not treating Welsh-registered patients as second-class citizens:
No one is saying "The Welshman can wait
a bit longer" […] The Welsh have set a 26-week waiting
time standard. The Welsh Government can decide to set a different
waiting time standard. In England, we have set it […] at
18 weeks. That is a decision for the Welsh Government.[74]
86. Many Clinical
Commissioning Groups operate two waiting lists, which differentiate
between patients on whether they are 'Welsh' patients or 'English'
patients. It is our view that providers should not be in this
position; the procedures that English hospitals need to operate
in this situation are a matter for the Welsh Government and the
Department of Health to resolve.
67 Welsh NHS Confederation (CBH0016) Back
68
Q178 Back
69
Shropshire Clinical Commissioning Group (CBH0011) Back
70
Q137 Back
71
Q193 Back
72
Powys Teaching Health Board (CBH0026) Back
73
Q194 Back
74
Q278 Back
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