Data are published on consultant-led Referral to Treatment (RTT) waiting times for patients who were treated during May 2012 and patients waiting to start treatment at the end of May 2012.
• During May 2012, 92.6% of admitted patients and 97.9% of non-admitted patients started treatment within 18 weeks. For patients waiting to start treatment (incomplete pathways) at the end of May 2012, 94.4% were waiting within 18 weeks.
• 323,588 RTT patients started admitted treatment and 946,806 started non-admitted treatment during May 2012. The number of RTT patients waiting to start treatment at the end of May 2012 was around 2.56 million patients.
• The average (median) time waited for patients completing an RTT pathway in May 2012 was 8.4 weeks for admitted patients and 4.1 weeks for non-admitted patients. For patients waiting to start treatment at the end of May 2012 the median waiting time was 5.3 weeks.
• Average (median) waiting times have been broadly stable, following a seasonal pattern, over the past three years. May 2012 median waiting times are consistent with the usual seasonal position.
Imperial College Healthcare NHS Trust did not submit any (admitted, non-admitted and incomplete) RTT pathway data for May 2012.
Detailed tables of waiting times by treatment function (specialty), commissioner and provider are available on the DH website.
Revisions to RTT data for the period September 2011 to April 2012 were also published. The revisions include data that was previously missing from Mid Staffordshire NHS Foundation Trust and The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust. The impact at national level is shown in Table 3 and full revised data can also be found on the DH website.
Notes to Editors
For admitted patients, adjusted data (allowing for legitimate pauses of the RTT clock) is used to measure waiting times.
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 on 28 November 2007. These documents were updated in January 2012 and can be found on the DH 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) and 95th percentile 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.
The 95th percentile waiting time reveals how long patients at the higher end of the waiting time distribution waited to start treatment. It is a statistical measure of the RTT waiting times distribution. The 95th percentile waiting time is the time that 95% of patients waited less than, and 5% of patients waited more than.
It should be noted that median and percentile times are calculated from aggregate data, rather than patient level data, and therefore are only estimates of the position on average waits.
8. 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.
9. 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.
10. 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
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:
Knowledge and Intelligence
Department of Health
Room 4E63, Quarry House, Quarry Hill, Leeds LS2 7UE