NHS health boards in England have been accused of deliberately delaying patient care by implementing minimum wait times for various treatments, according to an investigation by the British Medical Journal (BMJ).
The analysis, which utilised the Freedom of Information Act, revealed that integrated care boards (ICBs) are enforcing delays of up to 16 weeks for procedures such as hip, knee, and cataract surgery. These measures are reportedly being used as a strategy to manage demand and control costs within the healthcare system.
Records obtained from 35 of England’s 36 ICBs showed that 17 of these bodies have introduced minimum waits ranging from 12 to 16 weeks for key procedures. This practice has drawn criticism from leading medical professional bodies, with the Royal College of Surgeons (RCS) expressing significant concern over the scale of the delays, which can prolong patient suffering.
Among the ICBs identified, Shropshire, Telford and Wrekin, and West Yorkshire have established a minimum wait of 16 weeks for all routine procedures. West Yorkshire specifically stated a target for 90 per cent of patients to wait at least 16 weeks, while also noting this target provided doctors with "flexibility" to prioritise patients at risk of clinical deterioration if delays were extended.
Shropshire, Telford and Wrekin indicated that its 16-week minimum waiting time threshold was implemented to "promote fairness, reduce variation, and ensure that all patients receive timely and equitable access to elective services."
Further examples from the investigation highlighted other ICBs with similar policies. Birmingham, for instance, has a "minimum wait for first definitive treatment of 14 weeks for planned/non-urgent elective care," unless clinical urgency is demonstrated. Humber and North Yorkshire, along with NHS Hereford and Worcestershire, reported "activity planning assumptions" that factor in average waiting times of 16 weeks and a minimum of 14 weeks respectively for routine planned admitted procedures.
Dorset's independent sector surgical providers are expected to adhere to a minimum wait of 14 weeks from referral date, according to their contractual activity planning assumptions. Somerset has also stated that no patients should be treated under 14 weeks, unless they are classified as priority patients or require urgent tests and scans.
Tim Lane, president of the Royal College of Surgeons of England, voiced strong concerns about the findings. "We recognise the significant financial and capacity pressures facing the NHS, but patients who are clinically ready for treatment should not be deliberately made to wait," he said. Mr Lane warned that "unnecessary delays can prolong pain, limit mobility, increase anxiety and allow conditions to deteriorate."
He emphasised that "access to treatment should be determined by clinical need, not where a patient lives," suggesting that "widespread use of minimum waits risks creating a postcode lottery and further delaying care." Mr Lane called for increased capital investment, improved infrastructure, and better use of existing capacity to ensure patients receive treatment promptly, asserting that "minimum waits are not a substitute for addressing the NHS’s underlying capacity problems."
Professor Victoria Tzortziou Brown, president of the Royal College of GPs, described long waits as "frustrating for patients," particularly those living with pain that impacts their daily lives. She noted that these prolonged waits often lead patients to seek ongoing support from their GPs, adding to "already intense workload pressures facing general practice."
"We understand the enormous pressures facing hospitals and the capacity constraints that can lead to long waits, but decisions about when a patient receives treatment should be based on their clinical needs," Professor Tzortziou Brown stated. She concluded that "blanket minimum waiting times that require patients to wait longer than clinically necessary for administrative or financial reasons are difficult to justify, particularly where patients could otherwise be treated sooner."
Sally Gainsbury, a senior policy analyst at the Nuffield Trust think tank, told the BMJ that "limiting activity by a certain minimum waiting time can be an equitable and rational response to making sure your budget is spread evenly across your population." However, she expressed concern that "there isn’t clarity on how to do this fairly."
In response to the investigation, an NHS spokesperson commented: "While commissioned wait policies help the NHS make the best possible use of its services, staff and budgets – all patients are seen in order of clinical need." The spokesperson added: "We recognise that any wait for treatment can be difficult for patients, and we would not expect any organisation to commission waits that risks breaching NHS Constitution standards, which set an 18-week maximum wait for elective treatment."
