Right to start consultant-led treatment within 18 weeks

Patients’ right to treatment (RTT): rules and definitions for ensuring the waiting-time clock starts and stops fairly and consistently.


Referral to treatment consultant-led waiting times rules suite: revised for April 2014

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The October 2015 Referral to Treatment consultant-led waiting times Rules Suite is the current version of this document.

Patients have a right to start consultant-led treatment within 18 weeks of referral or request an offer of alternative providers that can start their treatment sooner. The NHS must take all reasonable steps to meet patients’ requests.

The maximum waiting times legislation requires commissioners to consider the ‘Referral to treatment consultant-led waiting times rules suite’. The rules suite includes:

  • national waiting time rules
  • definitions
  • guidance on applying the national rules locally
  • guidance on reviewing the pathways of patients who have waited longer than 18 weeks before starting their treatment
  • guidance on clinical exceptions to the NHS Constitution right to access services within maximum waiting times

On 1 October 2015, the National Health Service Commissioning Board and Clinical Commissioning Groups (Responsibilities and Standing Rules) (Amendment) (No.2) Regulations 2015 came into effect, removing the provision for a patient pause. The October 2015 Rules Suite reflects this change.

Although the NHS will wish to maintain a local record of delays resulting from patient choice - to aid good waiting list management and to ensure patients are treated in order of clinical priority – they will not affect a patient’s RTT ‘clock’, and there is no provision to report pauses or suspensions in RTT waiting time clocks in monthly RTT returns to NHS England under any circumstances.

Monthly referral to treatment data, guidance and practical tools for waiting list management are available from NHS England.