Nearly half of health boards in England are deliberately delaying care for patients by imposing minimum waiting times in an attempt to manage demand and control costs, reveals exclusive data published by The BMJ today.
A total of 17 of the 36 Integrated Care Boards (ICBs) - responsible for planning health services for their local population - have introduced minimum waits of between 12 and 16 weeks for procedures including hip, knee and cataract surgery.
The Royal College of Surgeons (RCS) said it was "concerned by the scale" of measures that can prolong patients' pain, while the Royal College of General Practitioners (RCGP) said the waits were "difficult to justify."
The BMJ sent Freedom of Information requests to all 36 ICBs in England. Some 35 boards responded (a 97% response rate).
Of these, 17 (49%) confirmed they had imposed some form of minimum wait. A further 17 ICBs said they did not have a minimum wait, while one - NHS North East London - was unable to say.
Of the ICBs with minimum waiting times in place, two - Shropshire, Telford and Wrekin and West Yorkshire - have introduced a minimum wait of 16 weeks for all routine procedures.
But experts warn that imposing blanket 16-week waits in particular risks breaching the NHS Constitution's 18-week referral-to-treatment standard - a target that has not been hit nationally since February 2016.
The responses show that ICBs with policies in place include South East London, which has introduced a 16-week minimum wait for cataract treatment, and Humber and North Yorkshire, which has imposed a "planning assumption" of 16 weeks, under which NHS and independent providers expect patients to wait an average of 16 weeks.
North East and North Cumbria has imposed a similar 'planning assumption' that patients will wait an average 15 weeks for all elective procedures and six other ICBs (Birmingham and Solihull, Black Country, Coventry and Warwickshire, Devon, Hereford and Worcestershire and Somerset) have a minimum wait of 14 weeks for all elective procedures.
Meanwhile, Leicester, Leicestershire and Rutland has a 14-week minimum wait for orthopaedics and ophthalmology, Thames Valley has a 14-week minimum wait for cataracts and Dorset has a 14-week minimum wait for independent surgical providers of NHS care.
Some ICBs told The BMJ the measures allowed them to make the best use of financial resources and ensure patients were treated fairly.
Reacting to the data, RCS England president Tim Lane said: "We recognise the significant financial and capacity pressures facing the NHS, but minimum waits risk meaning that patients who are clinically ready for treatment are deliberately made to wait."
He added: "For patients, this can mean living with pain, living with reduced mobility, experiencing anxiety for longer, as well as being unable to work or carry out normal activities. There is also a risk that a patient's condition may deteriorate while they are waiting, potentially changing their clinical needs and priority for treatment."
RCGP president Victoria Tzortziou Brown said blanket minimum waiting times "are difficult to justify, particularly where patients could otherwise be treated sooner."
She added: "At a time when the NHS is trying to bring waiting times down, we should be doing everything possible to ensure patients can get the care they need without unnecessary delays."
Sally Gainsbury, senior policy analyst at the Nuffield Trust think-tank, told The BMJ: "Limiting activity by a certain minimum waiting time can be an equitable and rational response to making sure your budget is spread evenly across your population." But added: "I'm concerned there isn't clarity on how to do this fairly."
Commenting on the use of minimum waits, an NHS spokesperson said: "While commissioned wait policies help the NHS make the best possible use of its services, staff and budgets - all patients are seen in order of clinical need."
They added: "We recognise that any wait for treatment can be difficult for patients, and we would not expect any organisation to commission waits that risks breaching NHS Constitution standards, which set an 18-week maximum wait for elective treatment."
