Press release

Statistical Press Notice – NHS Referral To Treatment (RTT) Waiting Times Data – December 2012 & Annual Statistical Report 2012

This news article was published under the 2010 to 2015 Conservative and Liberal Democrat coalition government

Data are published on consultant-led Referral to Treatment (RTT) waiting times for patients who were treated during December 2012 and patients waiting to start treatment at the end of December 2012.

Main Findings - December 2012

 

  • During December 2012, 93.1% of admitted patients and 97.7% of non-admitted patients started treatment within 18 weeks. For patients waiting to start treatment (incomplete pathways) at the end of December 2012, 94.5% were waiting within 18 weeks.

 

  • 258,137 RTT patients started admitted treatment and 756,467 started non-admitted treatment during December 2012. The number of RTT patients waiting to start treatment at the end of December 2012 was around 2.56 million patients.

 

  • The average (median) time waited for patients completing an RTT pathway in December 2012 was 8.0 weeks for admitted patients and 4.0 weeks for non-admitted patients. For patients waiting to start treatment at the end of December 2012 the median waiting time was 6.1 weeks.

 

North Bristol NHS Trust and Bradford Teaching Hospitals NHS Foundation Trust did not submit incomplete RTT pathway data for December 2012.

 

Detailed tables of waiting times by treatment function (specialty), commissioner and provider are available on the Department of Health website.

 

 

Main Findings - 2012 Annual report

 

  • The majority of RTT patients started treatment within 18 weeks of referral in 2012. The percentage of patients who started admitted treatment within 18 weeks at England level has been between 89.6% and 93.7% since January 2009. While the percentage of patients who started non-admitted treatment within 18 weeks has been between 97.0% and 98.2%.

 

  • The percentage of incomplete pathways - patients still waiting to start treatment at the end of the month - within 18 weeks has risen from 91.4% at the end of December 2011 to 94.5% at the end of December 2012.

 

  • In 2012, the admitted and non-admitted standards were met nationally in all 12 months of the calendar year. A new standard for incomplete pathways was introduced from April 2012. This standard was met early nationally and in all 12 months of the calendar year.

 

  • In 2012, the average patient waited around eight and a half weeks to start admitted treatment, four weeks to start non-admitted treatment, and the average patient waiting for treatment at the end of the month had been waiting around five and a half weeks.

 

  • The number of RTT patients who started consultant-led treatment in 2012 has been similar to previous years’ levels of activity. Each month around 300,000 RTT patients start admitted treatment and around 870,000 start non-admitted treatment.

 

  • The numbers of RTT patients waiting at the end of each month has been around 2.5 million patients since October 2008. There is a seasonal trend, where there are fewer patients waiting during winter - around 2.4 million - and more patients waiting during summer - around 2.7 million.

 

The full annual statistical report on consultant-led RTT waiting times can be found via the Department of Health website.  

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**

Table 1 -  December 2012 Referral to Treatment (RTT) waiting times by treatment function, England

 

Admitted Pathways

Non-Admitted Pathways

Incomplete Pathways

Treatment function

Total (all)

% within 18 weeks

Total (all)

% within 18 weeks

Total (all)

% within 18 weeks

General Surgery

34,801

92.1%

50,920

96.6%

240,609

92.4%

Urology

17,562

93.4%

23,502

97.0%

131,725

93.4%

Trauma & Orthopaedics

48,303

89.5%

68,836

96.4%

361,134

91.3%

ENT

13,980

92.3%

52,536

97.6%

176,646

94.7%

Ophthalmology

34,666

93.7%

68,972

97.8%

270,803

95.7%

Oral Surgery

13,469

93.8%

27,673

96.4%

132,957

95.2%

Neurosurgery

2,290

86.7%

3,901

95.6%

23,394

91.0%

Plastic Surgery

9,814

93.1%

7,605

97.0%

41,080

92.0%

Cardiothoracic Surgery

1,763

90.5%

832

98.2%

6,933

90.7%

General Medicine

3,633

98.8%

16,877

98.1%

47,538

96.3%

Gastroenterology

10,901

98.6%

20,996

95.9%

106,952

95.7%

Cardiology

7,340

94.9%

33,160

97.6%

116,904

95.7%

Dermatology

6,221

96.2%

48,209

98.0%

124,739

97.0%

Thoracic Medicine

1,435

99.0%

15,354

97.8%

47,359

96.0%

Neurology

819

98.2%

19,914

97.0%

69,217

96.1%

Rheumatology

1,428

99.1%

15,905

98.1%

43,176

97.3%

Geriatric Medicine

220

99.5%

8,046

99.1%

15,947

97.9%

Gynaecology

21,558

95.3%

51,849

98.6%

158,610

96.0%

Other

27,934

94.0%

221,380

98.4%

446,085

95.2%

England

258,137

93.1%

756,467

97.7%

2,561,808

94.5%

**
**

Table 2 - Referral to Treatment (RTT) waiting times, England

 

 

Admitted pathways

Non-Admitted pathways

Incomplete pathways

Month

Median wait (weeks)

95th percentile (weeks)

% within 18 weeks

Median wait (weeks)

95th percentile (weeks)

% within 18 weeks

Median wait (weeks)

95th percentile (weeks)

% within 18 weeks

March 2007

18.8

52+

48.3%

-

-

-

-

-

-

August 2007

15.6

52+

56.0%

7.4

52+

76.1%

14.3

52+

57.2%

March 2008

8.1

27.3

87.1%

3.9

21.8

93.4%

9.8

52+

66.0%

March 2009

7.7

20.0

93.0%

3.8

15.6

97.4%

5.6

29.8

87.6%

March 2010

8.0

21.2

92.0%

3.9

15.4

97.8%

5.2

23.3

91.1%

March 2011

7.9

23.4

89.6%

3.7

15.8

97.3%

5.5

25.4

89.4%

November 2011

8.1

22.1

91.0%

4.0

16.1

97.0%

5.7

22.5

91.3%

December 2011

7.8

21.9

91.4%

3.8

15.7

97.2%

6.3

22.5

91.4%

January 2012

8.8

22.1

91.3%

4.4

16.1

97.1%

5.9

21.5

92.2%

February 2012

8.7

21.9

91.2%

3.6

16.1

97.1%

5.2

21.0

92.6%

March 2012

8.1

22.2

91.1%

3.6

15.8

97.4%

5.2

20.2

93.3%

April 2012

8.1

21.7

91.9%

4.0

15.0

97.7%

5.5

19.5

94.1%

May 2012

8.4

21.6

92.6%

4.1

15.2

97.9%

5.3

18.7

94.4%

June 2012

8.4

21.4

92.1%

4.2

15.6

97.8%

5.7

19.0

94.1%

July 2012

8.5

20.8

92.7%

4.1

15.7

97.7%

5.5

19.2

94.0%

August 2012

8.3

20.9

92.7%

4.3

15.7

97.7%

5.8

18.6

94.5%

September 2012

8.8

21.2

92.2%

4.7

16.1

97.4%

5.8

18.7

94.4%

October 2012

8.6

20.9

92.7%

4.2

16.0

97.5%

5.3

18.3

94.8%

November 2012

8.3

20.8

92.7%

4.2

15.9

97.5%

5.4

18.3

94.8%

December 2012

8.0

20.5

93.1%

4.0

15.5

97.7%

6.1

18.7

94.5%

 

Notes:

  1. Median and 95th percentile times are calculated from aggregate data, rather than patient level data, and therefore are only estimates of the position on average waits.

  2. Where the 95th percentile falls in the over 52 week time band, the estimates are less accurate. Hence, such figures are shown as “52+” weeks.

  3. Admitted RTT pathways are waiting times for patients whose treatment started during the month and involved admission to hospital.

  4. Admitted (unadjusted) RTT data were first published in March 2007. Admitted RTT data on an adjusted basis were first published in March 2008.

  5. Adjustments are made to admitted RTT pathways for clock pauses, where a patient had declined reasonable offers of admission and chosen to wait longer.

  6. Non-admitted RTT pathways are waiting times for patients whose treatment started during the month and did not involve admission to hospital.

  7. Incomplete RTT pathways are waiting times for patients still waiting to start treatment at the end of the month.

  8. Non-admitted and Incomplete RTT data were first published in August 2007.

**
**

Notes** to Editors**

 

For admitted patients, adjusted data (allowing for legitimate pauses of the RTT clock) is used to measure waiting times.

 

Statistical Notes** **

 

1.  National Statistics

 

The United Kingdom Statistics Authority has designated these statistics as National Statistics, in accordance with the Statistics and Registration Service Act 2007 and signifying compliance with the Code of Practice for Official Statistics. Designation can be broadly interpreted to mean that the statistics:

  • meet identified user needs;
  • are well explained and readily accessible;
  • are produced according to sound methods, and
  • are managed impartially and objectively in the public interest.

 

Once statistics have been designated as National Statistics it is a statutory requirement that the Code of Practice shall continue to be observed.

 

2. Referral to Treatment “pathways” and “clock stops”

 

Patients referred for non-emergency consultant-led treatment are on Referral to Treatment (RTT) pathways. An RTT pathway is the length of time that a patient waited from referral to start of treatment, or if they have not yet started treatment, the length of time that a patient has waited so far.

 

The following activities end the RTT pathway and lead to the RTT clock being stopped:

  • first treatment - the start of the first treatment that is intended to manage a patient’s disease, condition or injury in a RTT pathway
  • start of active monitoring initiated by the patient
  • start of active monitoring initiated by the care professional
  • decision not to treat - decision not to treat made or no further contact required
  • patient declined offered treatment
  • patient died before treatment

 

3. Operational waiting time standards

 

The waiting time standards set the proportion of RTT pathways that must be within 18 weeks. These proportions leave an operational tolerance to allow for patients for who starting treatment within 18 weeks would be inconvenient or clinically inappropriate.

These circumstances can be categorised as:

  • Patient choice - patients choose not to accept earliest offered appointments along their pathway or choose to delay treatments for personal or social reasons
  • Co-operation - patients who do not attend appointments along their pathways
  • Clinical exceptions - where it is not clinically appropriate to start a patient’s treatment within 18 weeks

 

The admitted waiting time standard is 90% and applies to admitted adjusted RTT pathways. Admitted pathways are the waiting times for patients whose treatment started during the month and involved admission to hospital. These are also often referred to as inpatient waiting times, but include the complete time waited from referral until start of inpatient treatment.

 

The non-admitted waiting time standard is 95%. Non-admitted pathways are the waiting times for patients whose treatment started during the month and did not involve admission to hospital. These are also often referred to as outpatient waiting times, but they include the time waited for patients whose RTT waiting time clock either stopped for treatment or other reasons, such as a patient declining treatment.

 

The incomplete waiting time standard is 92%. The Department of Health introduced this new operational standard from April 2012 onwards. Incomplete pathways are the waiting times for patients waiting to start treatment at the end of the month. These are also often referred to as waiting list waiting times and the volume of incomplete RTT pathways as the size of the RTT waiting list.

 

4. Referral to Treatment waiting times data collection

 

Referral to Treatment (RTT) data is collected from NHS providers (NHS Trusts and other providers) and signed off by commissioners (Primary Care Trusts).

 

The data measures RTT waiting times in weeks, split by treatment function. The treatment functions are based on consultant specialties. The length of the RTT pathway is reported for patients whose RTT clock stopped during the month.

 

The Department of Health published the RTT Rules Suite on28 November 2007. These documents were updated in January 2012 and can be found on the Department of Health website.

 

The data return includes all patients whose RTT clock stopped at any point in the reporting period. A column has been provided to enter data for patients whose length of RTT period is unknown, i.e. patients who have had a clock stop during the month but where the clock start date is not known.

 

For admitted patients, the RTT time is measured on an adjusted basis - from the date the RTT clock starts to the date that the RTT clock stops, allowing for legitimate pauses as described in the above RTT Rules Suite.

 

For non-admitted patients, the RTT time is measured on an unadjusted basis - from the date the RTT clock starts to the date that the RTT clock stops, as detailed in DSCN 17/2006.

 

For patients on incomplete pathways, the RTT time is measured on an unadjusted basis. Incomplete pathways represent those patients who have been referred on to consultant-led referral to treatment pathways, but whose treatment had not yet started at the end of the reporting period. These patients will be at various stages of their pathway, for example, waiting for diagnostics, an appointment with a consultant, or for admission for a procedure.

 

5. Data Availability

 

Data for admitted patients (patients whose RTT clock stopped with an inpatient/ day case admission) has been published each month since January 2007 on an unadjusted basis.

 

Data for admitted patients (patients whose RTT clock stopped with an inpatient/ day case admission) has been published each month since March 2008 on an adjusted basis.

 

Data for non-admitted patients (patients whose RTT clock stopped during the month for reasons other than an inpatient/day case admission) and incomplete RTT times for patients whose RTT clock is still running has been published each month since August 2007.

 

RTT waiting times data are published to a pre-announced timetable, roughly 7 weeks after the end of the reference month. Publication occurs on a Thursday and is always on or after the 31st working day after the end of the reporting month.

 

6. Provider and Commissioner based data

 

Commissioner based returns reflect data on a responsible population basis, which is defined as:

  • all those patients resident within the PCT boundary; plus
  • all patients registered with GPs who are members of the PCT, but are resident in another PCT; minus
  • All patients resident in the PCT, but registered with a GP who is a member of another PCT

 

Provider based returns cover patients for whom English commissioners are responsible.

 

7. Average (median) waiting times

 

The median is the preferred measure of the average waiting time as it is less susceptible to extreme values than the mean. The median waiting times is the middle value when all patients are ordered by length of wait. This is the midpoint of the RTT waiting times distribution. For completed pathways, 50% of patients started treatment within the median waiting time, and for incomplete pathways 50% of patients were waiting within the median waiting time.

 

It should be noted that median times are calculated from aggregate data, rather than patient level data, and therefore are only estimates of the position on average waits.**

 

7. Interpretation of RTT waiting times

 

Care should be taken when making month on month comparisons of these figures.  Measures of waiting time performance are subject to seasonality. For example, the presence of bank holidays or the number of weekends in a calendar month both affect the number of working days. Similarly, adverse weather may result in emergency pressure and impacts upon the health service’s ability to preserve elective capacity. These factors can affect waiting times and should be considered when making comparisons across time.

 

8. NHS Operating Framework 2012-13

 

The operational standards of 90 per cent for admitted and 95 per cent for non-admitted completed waits as set out in the NHS Constitution remain. In order to sustain the delivery of these standards, trusts will need to ensure that 92 per cent of patients on an incomplete pathway should have been waiting no more than 18 weeks. The referral to treatment (RTT) operational standards should be achieved in each specialty by every organisation and this will be monitored monthly.

 

9. Feedback welcomed

 

We welcome feedback on the content and presentation of RTT statistics within this Statistical Press Notice and those published on the DH website. If anyone has any comments on this, or any other issues regarding RTT data and statistics, then please email RTTdata@dh.gsi.gov.uk

 

 

Additional Information

 

For press enquiries contact the Department of Health Media Centre. Please refer to the Department of Health’s website for the relevant contact details.

 

The Government Statistical Service (GSS) statistician responsible for producing these data is:

 

Mark Svenson

Knowledge and Intelligence

Department of Health

Room 8E28, Quarry House, Quarry Hill, Leeds LS2 7UE

Email: RTTdata@dh.gsi.gov.uk