‘Contradiction' in figures makes health experts question NHS data

Leader Live

11 hours ago

Experts suggest that more patients are being referred for treatment than leaving the waiting list, despite the overall waiting list coming down.
Analysis found that in May, for every 100 referrals for pre-planned care, only 86 patient 'pathways' were complete – a scenario that would expect to see the waiting list getting bigger.
But the official figures for May, published last month, show that the waiting list for routine hospital treatment in England had dropped to its lowest level for more than two years.
'There appears to be a contradiction in the data,' analysts from the Nuffield Trust think tank said.
Writing a piece for part of the Quality Watch programme, the experts claim that an increase in NHS activity alone has not been enough to cause the reduction in the waiting list.
Their new report examines so-called 'unreported removals', which occur when someone is taken off the waiting list for a reason other than that person having received their treatment that month.
The report says that over the last two financial years there has been an average of 244,500 unreported removals a month.
Though the waiting list has started to go down, unreported removals have gone up, they add.
Officials from the Department and Health and Social Care insist that over the last 12 months, the number and percentage of unreported removals are lower than 2019.
The new report points out that some of these unreported removals will represent patients that did get treatment but it was not recorded properly at the time.
Another issue could be problems with NHS software and data management processes.
The authors of the review wrote: 'Improving the data quality of waiting lists is important to ensure that people who should not be on the list, like people who have been treated privately or left the country, are no longer counted among those waiting to be seen.
'However, accusations of gaming the validation process, by removing referrals from the waiting list inappropriately without treatment, are likely to persist in the absence of transparency about what actions the unreported removals materially represent.
'The NHS is delivering more planned care, but still not enough to keep up with demand.
'The planned care that is reported is not enough to explain the reduction in the elective waiting list, and the publicly available data provides little more insight.'
Officials estimate that 85% of the reduction in the waiting list is because of increased NHS 'activity' and suggest that 15% is because of unreported removals.
According to the latest NHS figures, an estimated 7.36 million treatments were waiting to be carried out at the end of May, relating to just under 6.23 million patients, down from 7.39 million treatments and just over 6.23 million patients at the end of April.
These are the lowest totals since March 2023 for treatments and April 2023 for patients.
The list hit a record high in September 2023, with 7.77 million treatments and 6.50 million patients.
The size of the list had been on an upward trend for much of the last 10 years, passing three million treatments in 2014, four million in 2017, five million in 2021 and seven million in 2022.
In February 2020, the last full month before the start of the Covid-19 pandemic, the list stood at 4.57 million treatments.
The authors of the latest review add: 'The information available in the public domain is insufficient for independent scrutiny of the elective waiting list, and consequently for holding government to account.
'Removals from the waiting list should be described in publicly available data in a meaningful way; the current process is unduly obscure.
'Until more transparent reporting is provided, accountability around unreported removals remains impossible and the planned care waiting list will continue to be a misleading indicator of how the NHS is dealing with demand.'
It comes as the NHS in England is to reveal its latest waiting list figures on Thursday.
Commenting on the analysis, an NHS England spokesperson said: 'NHS staff have made significant progress in reducing waiting lists in the last year – down by more than 260,000 since June 2024 – and this is driven by the fact that 2,300 more patients are receiving treatment every day compared to last year.'
'While the validation process has a small impact on the overall waiting list – as is made crystal clear in our published monthly waiting list data – it's right we regularly clinically review those waiting so hospitals can prioritise patients more accurately and deploy their resources efficiently.'
A Department of Health and Social Care spokesperson added: 'Our drive to clear the huge waiting list backlog we inherited includes making sure all patients are getting the right treatment as quickly as possible.
'That's why we are supporting GPs to seek specialist advice before making referrals, and screening existing waiting lists to check that all patients need to be on there – freeing up capacity to get more people seen more quickly.
'This is one element of our wider work to cut waiting times for patients and improve productivity through our Plan for Change, through which we have already delivered over four million extra appointments and cut the waiting list by 260,000.'