Website of the Department of Health

Introduction

12.1 The public's top concern about the NHS is waiting for treatment. Waiting to see a GP, waiting to be seen in a casualty department, waiting to get into hospital and, sometimes, waiting to get out of hospital. A combination of investment and reform will allow progress on each of these fronts.

Primary care

12.2 By the end of 2000 NHS Direct, the 24-hour telephone helpline, will have gone nationwide. By 2004 it will be providing health information via digital TV as well as via the telephone and internet. By then there will be over 500 NHS Direct information points providing touch-screen information and advice about health and the health service in places like shopping centres and railway stations.

12.3 Starting in 2001, patients will get greater access to authoritative information about how they can care for themselves and their families under the aegis of NHSplus which will produce and kitemark books, leaflets and other written material.

12.4 By 2001, there will be new quality standards and closer integration too between NHS Direct and GP out-of-hours services. By 2004 a single phone call to NHS Direct will be a one-stop gateway to out-of-hours healthcare, passing on calls, where necessary, to the appropriate GP co-operative or deputising service.

12.5 By 2002 all NHS Direct sites will refer people, where appropriate, to help from their local pharmacy. There will be better out-of-hours pharmacy services and a wider range of over-the-counter medicines available. By 2004 every primary care group or trust will have schemes in place so that people get more help from pharmacists in using their medicines. There will be repeat dispensing schemes nationwide to make obtaining repeat prescriptions easier for patients with chronic conditions. These changes will speed up services and help relieve pressures on GP surgeries.

12.6 By 2004, patients will be able to see a primary care professional within 24 hours, and a GP within 48 hours. Half of all practices already achieve this target as a result of careful organisation. In future, all practices will be required to guarantee this level of access for their patients, either by providing the service themselves, or by entering into an arrangement with another practice, or by the introduction of further NHS walk-in centres.

12.7 By 2004 patients who currently have to go to hospital will be able to have tests and treatment in primary care centres as staff numbers and skills expand:

Dentistry

12.8 The Government is firmly committed to making high quality NHS dentistry available to all who want it by September 2001. The initiatives we have taken since 1997 have already made a real difference but more needs to be done. In future, NHS Direct will help direct patients to NHS dentistry. The Government will fund more dental access centres and improvements to dental practices. It will reward dentists' commitment to the NHS and foster better quality services for patients, making NHS dentistry a modern and truly national service again. Health authorities will take the lead in delivering the changes which patients expect.

Intermediate care

12.9 By 2004 we will end widespread bed blocking. All parts of the country will have new intermediate care services which will be underpinned by new arrangements to ensure more seamless care for patients. We will introduce new standards to ensure every patient has a discharge plan including an assessment of their care needs, developed from the beginning of their hospital admission. Together these measures mean that patients should not have their discharge from hospital delayed because they are awaiting assessment, support at home (adaptation, equipment or package of care), or suitable intermediate or other NHS care.

Hospital care

12.10 By 2004 no-one should be waiting more than four hours in accident and emergency from arrival to admission, transfer or discharge. Average waiting times in accident and emergency will fall as a result to 75 minutes. By then we will have ended inappropriate trolley waits for assessment and admission. Of course some patients such as those emergencies arriving by ambulance will clinically need to be assessed on a trolley, but after that if they need a hospital bed they should be admitted to one without undue delay.

12.11 This will involve major changes to the way that hospitals work. It may require more staff and the creation of medical assessment and admissions units in all hospitals that do not have them. It will require new working practices, with nurses taking on new roles including the right to admit patients and order diagnostic procedures. Patients with minor injuries will often be treated by appropriately trained primary care staff working in accident and emergency departments. The new Modernisation Agency will work with hospitals to spread best practice in accident and emergency services.

New maximum waiting times

12.12 Waiting for treatment has been part and parcel of the way the NHS has worked since its formation. It will require fundamental and comprehensive reform to tackle this problem.

12.13 At present the average wait to see a consultant for an outpatient appointment is seven weeks and the average time that people have been waiting for an operation is three months. But some people wait much longer than this - up to 18 months for inpatient treatment - and it is this which so concerns the public.

12.14 There are several reasons for long waiting times:

12.15 Each of these problems will be tackled as part of a war on waiting. As chapters 4 and 5 described, the NHS Plan will see year on year increases in equipment, facilities and staff. As the extra capacity comes on stream so we will be able to reduce waiting times. Those areas where there are particular problems will be targeted for special action - though it will take time to get the right supply of consultants and other staff into each specialty.

12.16 The introduction of on-the-spot booking systems will not just make getting a hospital appointment more convenient for patients. It also acts as a driver of much more fundamental reform. Booking appointments forces hospitals to organise their clinic slots and theatre sessions much more productively. It also brings a dramatic reduction in the number of cancelled appointments and the occasions when patients just do not turn up.

12.17 The booked appointment system also ensures that consultants have a regular scheduled stream of work. In addition, it involves GPs and hospital consultants sitting down and agreeing the basis on which referrals should be made and which services would best be carried out in the surgery and which in hospital. That in turn helps to make it more likely that consultants will spend their time seeing patients who have been referred appropriately.

12.18 So booking drives reform at several different levels. Booking is part and parcel of the wider and more radical process, described in chapter 6, of redesigning services round the patient, cutting out unnecessary stages of treatment, using staff more flexibly and reducing delays.

12.19 By increasing investment and making reforms the NHS Plan will be able to deliver major reductions in waiting times covering all stages of acute care. Within new guaranteed maximum waiting time backstops, patients will be treated according to individual clinicians' assessment of clinical urgency and need.

12.20 By the end of 2005:

12.21 Our eventual objective is to reduce the maximum wait for any stage of treatment to three months. Provided that we can recruit the extra staff, and the NHS makes the necessary reforms, we hope to achieve the objective by the end of 2008.

12.22 We will progress towards our objectives on a staged basis - the pace of progress being linked to the growth in staff. The Plan will see a staged reduction of maximum inpatient waits from 18 months through 15, 12, 9 down to 6, and eventually 3 months.

Conclusion

12.23 Expansion in staff alongside reforms to the way local health services are organised will deliver the most sustained assault on waiting the NHS has ever seen. The pace of progress is dependent upon the growth in staff. But by the end of 2005 waiting times at all stages in a patient's care will have fallen dramatically.