Patients risk being in ‘unnecessary pain' over NHS minimum waits for treatment
Some local NHS organisations have introduced minimum waiting times as part of their drive to control costs and set priorities, telling hospitals they will will only pay if patients have waited three months or more for things such as hip replacements.
As first reported in The Times, the policies include blanket minimum waiting times of 12-16 weeks in some regions.
In Devon, a 14-week wait has been applied to 'clinically routine cases' while in Shropshire, a minimum wait of 16-18 weeks applies 'unless there is verifiable clinical urgency', the Times reported.
In South Yorkshire, as a result of 'significant financial challenge' the region is 'requiring providers to slow down the rate of delivery to a minimum of 13 weeks', documents suggest.
In north-east London, bosses say an interim goal of treating 65% of patients within 18 weeks will be a maximum, citing a reduction in the money available for routine treatment.
Other regions vary more by type of treatment, with some putting blocks in place for cataracts or inpatient ear, nose and throat cases.
Earlier this year, NHS England published guidance with detail on minimum waits, saying hospital trusts and local commissioners must agree plans on the expected 'volume of activity' across the year.
It said commissioners may wish to set 'activity planning assumptions', which can include introducing minimum waiting times.
In April, NHS England chief executive Sir Jim Mackey told a Health Service Journal (HSJ) summit that the new rules would give commissioners 'the ability to say to providers…'You might be able to do a cataract in four days, but I want you to do it in 10 weeks, because that's what we've decided is necessary'.'
He suggested this may help support other priorities, for example big cancer or mental health waiting times.
However, experts said the move risked leaving people in pain or facing unnecessary delays.
Tim Mitchell, president of the Royal College of Surgeons of England, said: 'Used in this way, minimum waiting times risk distorting clinical priorities and leaving patients in unnecessary pain and anxiety.
'Treatment should be delivered as promptly as possible, based on clinical need.
'We recognise the financial pressures facing the NHS but delaying treatment to balance the books is not the answer.
'Instead, we need targeted investment to expand surgical capacity and upgrade the ageing NHS buildings and infrastructure that continue to hold back efforts to meet the 18-week waiting time target.'
An NHS spokesman said: 'We have asked all parts of the NHS to bring waiting times down while we continue to prioritise the most clinically urgent patients.
'There is no policy supporting minimum waits in the NHS and we will work closely with all systems to ensure they deliver the expected level of improvement in waiting times set out in our 25/26 planning guidance.'
NHS Integrated Care Boards (ICBs) have been contacted for comment.
Nuffield Trust senior policy analyst Sally Gainsbury said: 'This highlights the stark reality of a health service facing higher patient demand than it can meet within its budget and available capacity.
'The NHS has a responsibility to use its resources fairly and although patients will find minimum waiting times distressing, they can represent an attempt by the NHS to ensure patients with particular conditions, such as cataracts, do not in effect receive care at the expense of others.
'There are millions of people waiting for planned treatment, and the Government has made waiting times a key target for the next election.
'But this is not the only form of care the NHS provides. NHS organisations do need to strike a balance with those patients needing emergency care, primary care or mental health care, too. Balancing those competing demands is really difficult to do.
'With so much pressure on resources, there is a need for a shared understanding between the public and the NHS about how different treatments should be prioritised in a way people can agree is fair.
'Unfortunately, politicians are often reluctant to accept this need for honesty, and there is a real risk that the emphasis on the patient as a consumer of healthcare expected in the 10-year plan will exacerbate pressures.'
A spokeswoman for NHS South Yorkshire said there had been clinical input into the decision, adding: 'We are committed to making care better, faster and more efficient, as well as prioritising more urgent treatment such as for cancer.
'To make waiting times equitable across our region we have asked providers to work to a minimum wait of 13 weeks for routine care. This is within the 18-week constitutional standard.'
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
Sky News
27 minutes ago
- Sky News
Starmer to set out 10-year vision for NHS
Sir Keir Starmer will set out his 10-year vision for the NHS in what the government says is "one of the most seismic shifts" in the health service's history. He will pledge three main facets of the plan: moving care into the community, digitising the NHS, and a focus on sickness prevention. The prime minister will announce neighbourhood health services will be rolled out across England to improve access to the NHS and to shift care out of overstrained hospitals. PM 'might have to go in months' - politics latest 2:30 Sir Keir has already promised thousands more GPs will be trained, and to end the 8am "scramble" for an appointment. He also previously said his government will bring the NHS into the digital age, with "groundbreaking" new tools to support GPs rolled out over the next two years - including AI to take notes, draft letters and enter data. And he will promise new contracts that will encourage and allow GP practices to cover a wider geographical area, so small practices will get more support. Unite, one of the UK's largest healthcare unions, welcomed the plan cautiously but said staff need to be the focus to ensure people are better looked after. 2:04 Sir Keir said: "The NHS should be there for everyone, whenever they need it. "But we inherited a health system in crisis, addicted to a sticking plaster approach, and unable to face up to the challenges we face now, let alone in the future. "That ends now. Because it's reform or die." He said the government's plan "will fundamentally rewire and futureproof our NHS, so that it puts care on people's doorsteps, harnesses game-changing tech and prevents illness in the first place". The PM said it would not be an "overnight fix", but claimed Labour are "already turning the tide on years of decline", pointing towards more than four million extra appointments, 1,900 more GPs, and waiting lists at a two-year low. "But there's more to come," he promised. "This government is giving patients easier, quicker and more convenient care, wherever they live." 3:05 Neighbourhood health services The newly announced neighbourhood health services will provide "pioneering teams" in local communities, so patients can more conveniently access a full range of healthcare services close to home. Local areas will be encouraged to trial innovative schemes like community outreach door-to-door to detect early signs of illness and reduce pressure on GPs and A&E. The aim is to eventually have new health centres open 12 hours a day, six days a week to offer GP services as well as diagnostics, post-operative care and rehab. They will also offer services like debt advice, employment support, stop smoking help or weight management. More NHS dentists Dentists will also be part of the plan, with dental care professionals part of the neighbourhood teams. Dental "therapists" will carry out check-ups, treatments and referrals, while dental nurses could give education and advice to parents or work with schools and community groups. Newly qualified dentists will be required to practice in the NHS for a minimum period, which they have said will be three years.
Medical News Today
an hour ago
- Medical News Today
What to know about the Medicare Beneficiary Ombudsman (MBO)
Medicare is a complex system. The Medicare Beneficiary Ombudsman (MBO) is a client advocate who provides support and information to help enrollees understand their options and navigate ombudsman works within an organization on behalf of its clients to help resolve grievances and improve the organization's functioning. The MBO fills this role for the Medicare Medicare, individuals have clearly outlined rights and protections. These include the right to fair treatment and clear information. The MBO works to ensure that these rights are more about the role of the MBO, a person's rights under Medicare, and where to direct complaints or inquiries related to of the MBOThe MBO position was established by Congress in 2003 through the Social Security Act § MBO's overarching goal is to be an expert in the field of healthcare and Medicare education and help enrollees in various duties of the MBO, as described in the Social Security Act, include:Assisting with issues: The MBO helps beneficiaries by processing complaints, grievances, and requests for information related to Medicare. It also provides assistance during coverage information: The MBO works with Medicare counseling programs to ensure that beneficiaries have access to information regarding their Medicare options and to Congress: The MBO reports to Congress on the functioning of the MBO position and makes recommendations on its improvement. It also identifies and flags potential issues with Medicare coverage or payment questions that may receive attention from the MBO include those related to appeals, enrollment concerns, and claims. Individual rights under MedicareAs Medicare beneficiaries, people have various rights and rights include:fair and courteous treatmentnondiscriminationprivacy of personal and medical informationaccess to care for medically necessary servicesaccess to clear information about coverage and treatment optionsanswers to Medicare questionsMedicare protections ensure that people with Original Medicare receive written notice if any items or services will not be covered under Medicare. This is called an Advance Beneficiary Notice (ABN) of a person receives an ABN, they have a few options:They can choose to receive the noncovered services and have the provider submit a claim to Medicare. In this case, they pay the costs up front. They can file an appeal if Medicare denies the can choose to receive the noncovered services without their provider submitting a claim. In this case, they pay the full cost up front and cannot file an can also choose not to receive the services. In this situation, they do not need to pay any of the functions of the MBO is to ensure that people receive fair treatment within the Medicare a person believes they have been treated unfairly or that their rights or protections have been violated, they may wish to consult the MBO for to contact the MBOThere are various ways to get in touch with the MBO. If a person has a question or concern related to Original Medicare, their first course of action should be to contact Medicare at 800-633-4227 (TTY: 877-486-2048).If a person has Medicare coverage through a private insurance company, such as a Medicare Advantage (Part C) plan or Part D prescription drug plan, they should reach out to a representative of their plan MBO also works closely with State Health Insurance Assistance Programs (SHIPs). If a person has questions about claims, appeals, enrollment, or complaints, the local SHIP can assist them in finding a resolution. Finally, if a person has not found a resolution to their inquiry through the above methods, they can contact Medicare and request that their concerns be directed to the MBO is a Medicare representative who works on behalf of Medicare enrollees to ensure access to information and resolve MBO also submits an annual report to Congress with recommendations on how to improve the role and functioning of the Medicare a person has a question or grievance regarding Medicare, they can contact Medicare by phone or speak with a representative from their local State Health Insurance Assistance Program (SHIP). If these avenues cannot help resolve the query, a person can request that their case be sent to the MBO.
Medical News Today
an hour ago
- Medical News Today
Medicare appeals process after denial
Original Medicare, Medicare Advantage, and Part D plans can deny coverage for a health service or medication. However, individuals have a legal right to appeal the decision if they think it is incorrect.A person can submit an application form with a statement and some supporting evidence outlining why they disagree with Medicare's will then review the information and either allow or refuse the of Medicare termsOut-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and This is the amount of money someone pays each month for Medicare coverage. Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription is a Medicare appeal?People enrolled in Medicare have rights and protections regarding their healthcare services. One of these rights is the Medicare appeals allows a person to appeal a Medicare decision about coverage denial or late payments, such as Medicare appeals process has five levels, each with a separate review process. If Medicare approves an appeal at the first level, the process stops. Alternatively, if Medicare denies the initial appeal, the process can go to the next level, and so individual must collect supporting documents from their doctor or other medical professional to prove their appeal case to Medicare. They will submit these documents and the appeal form to are the reasons for appealing?People have the right to appeal if they disagree with Medicare's decision not to approve the following:a request for a healthcare service, supply, item, or prescription drug that Medicare should covera payment request for a healthcare service, supply, item, or prescription drug they have already received a request to change the amount someone pays for a healthcare service, supply, item, or prescription drugMedicare may deny coverage for the following reasons:The item, service, or prescription drug is not medically individual does not meet the eligibility requirements for does not cover the item, service, or prescription at any time.»Learn more:Understanding a Medicare denial of noticeThe appeal process starts when a Medicare beneficiary receives an official written notice that Medicare has denied coverage. Standard notice types include:Medicare summary notice (MSN): An MSN shows Medicare payments for covered services and items for the previous 3 months. It also indicates whether Medicare denies any item or Beneficiary Notice of Noncoverage (ABN): Doctors, other healthcare professionals, and suppliers issue ABN notices as an advanced warning that Medicare may not cover a service or Nursing Facility Advance Beneficiary Notice (SNF ABN): If someone is staying in a skilled nursing facility and approaching the maximum number of covered days, the facility issues the SNF Advance Beneficiary Notice (FFS ABN): This notice tells someone that Medicare will charge them for a service they had or are due to of Denial of Medical Coverage (Integrated Denial Notice): Medicare Advantage plans and Medicaid issue these notices if they will not cover any part of a Issued Notice of Noncoverage (HINN): Hospitals use this form if Medicare coverage for inpatient stays is of Medicare Non-Coverage (NOMNC): This notice is similar to the HINN, but it refers to inpatient care in an SNF, rehabilitation facility, or hospice. A person will receive this at least 2 days before the coverage the appeal processWhen Medicare sends a notice, it includes information about the appeals process. However, the various Medicare parts have different methods for starting an appeal, as follows:Original Medicare (parts A and B): Usually, people must first complete a Redetermination Request form for an appeal against a decision involving Original Part D: If a person wants to appeal a Part D decision, they will also usually need to begin by completing the Redetermination Request Advantage plans: Different rules apply to Medicare Advantage plans, and a person can contact their plan provider for information about appealing a appeals form requires basic personal information and some details of the claim. People must include details of the service or item they are appealing and why they think Medicare's decision is incorrect. They also need to provide supporting evidence, such as a doctor's letter, test results, or diagnosis notification limitsNotifications of decisions have various time will generally provide a decision within 60 days of receiving the expedited service request can take 24 to 72 hours, and a pre-service request can take 14 appeal levelsThe Medicare appeals process has five levels. If someone disagrees with a decision at any level, the appeal moves to the next level of review. At each level, Medicare sends out a decision letter, which includes details of the next levels are as follows:Level 1: This level is called redetermination. It is an initial review by a Medicare administrative 2: A qualified independent contractor reviews the 3: The Office of Medicare Hearings and Appeals (OMHA) reviews the appeal. The amount of the case must be at least $190 in 4: The Medicare Appeals Council reviews the 5: This is a judicial review by a federal district court. In 2025, the claim amount must be at least $1, can a person win a Medicare appeal?You cannot provide too much information. The more information a person provides, the greater the chance of a favorable outcome.A person should include as much supporting information as possible, including information from doctors, other medical professionals, or fast appealIf waiting for a decision would affect a person's health, they can ask for a fast appeal. An example of the need for a fast decision might be if someone is an inpatient in a hospital or SNF and is concerned that the facility is discharging them too this situation, the person has a right to an immediate review by the Beneficiary and Family Centered Care-Quality Improvement Organization (BFCC-QIO). The notice includes contact the BFCC-QIO is reviewing the case, the hospital cannot discharge the person, and they can stay in the hospital at no charge. The BFCC-QIO has 72 hours to decide the appeal.A person in a nursing facility or other inpatient setting will receive a notice at least 2 days before the coverage ends. The BFCC-QIO has until the end of the business on the day before an individual is due to be discharged to make a decision about the appeal.»Learn more:How to win a Medicare limits to an appealThe time limits for appeals depend on the Medicare Original Medicare (parts A and B), a person has 120 days from the day they received the notice to Medicare Advantage plans and Part D prescription drug coverage, a person has 60 days after receiving the notice to file an an appealIf a person decides to cancel a Medicare appeal, they should call Medicare at 800-633-4227 (TTY: 877-486-2048). They will need to provide the following information:their full nametheir Medicare ID numberthe date they submitted the appeal formdetails about the appealthe reason they are canceling the appealCosts to appealThe Medicare appeals process does not have any associated can get free help and advice with the appeals process and any other Medicare matter at their local State Health Insurance Assistance resourcesFor more resources to help guide you through the complex world of medical insurance, visit our Medicare monthly premium penaltiesAn individual can also appeal Medicare's penalty enrollment penalty Medicare charges a late enrollment penalty if a person does not enroll in Original Medicare (parts A and B) or Part D when they first qualify or do not have other coverage from another a person had health insurance from an employer but Medicare charged a late enrollment penalty, the person can appeal that decision. The evidence needed to appeal will include proof of adequate coverage comparable to that of Medicare.»Learn more:What to know about Medicare late enrollment monthly adjustment amount surchargeMedicare assesses a person's income as reported on their tax return from 2 years ago to calculate the Medicare Part B and Part D premiums. The Medicare income-related monthly adjustment amount (IRMAA) is a surcharge added to the standard a person disagrees with Medicare's assessment, they can appeal an IRMAA surcharge to the Social Security Administration (SSA).»Learn more:All about Medicare denies coverage of an item or service, an individual can appeal the decision. People must provide proof with a claim and submit this to Medicare with an application appeals process has five levels, each with different reviewers. If the review board refuses an appeal, it will move to the next level unless a person accepts the Medicare decides within 60 days, but people can get a fast appeal if it concerns an inpatient stay and if waiting for a decision could affect their health.
