The RTT 'Game' - are Trusts playing ball?


The penultimate year-end figures were published yesterday – in theory, elective activity should have been resumed and so there would be a decrease in the waiting list size. However, given the 2017/2018 planning guidance measures Trusts on the difference between the March 2018 and March 2019 figures, are Trusts wanting to get ahead of the game?

The guidance states that waiting list size should remain the same or decrease, so in order to achieve the guidance, the viable strategy would be for Trusts to concede a few goals now, so they can start from a position that they can feasibly improve upon. A 2-2 draw is a good result if you come back from 2-0 down at halftime.

Is this manifest in this month’s data? 


As the above graph shows, the number of 52-week-waiters increased from 1,869 in Jan to 2,236 in Feb, a near 20% increase and the highest increase we have seen since November to December 2017. Is this Trusts simply declaring all true 52-week-waiters or is it simply the knock-on effect of cessation of elective activity in January? Only individual Trusts know the answer.

Alongside this, as the above graph shows, the RTT incomplete waiting list has also increased from 3.73 million to 3.76 million - an increase of 32,634 patients!

Will March’s data show a further increase in the waiting list size, along with another increase in the number of patients waiting 52 weeks?

NHS Trusts are being forced to play a game, with ever moving goal posts, that requires an element of gamesmanship to be competitive. However, we must remember that the 18-week target of the NHS constitution reigns supreme and reducing the waiting time of each individual patient must remain the aim of the game - to ignore this is to score a spectacular own goal.

The trouble is, as we know, any deterioration in RTT performance in one month can take up to 6 months to recover from. How do NHS Trusts achieve the outputs of the planning guidance whilst staying true to the 18-week target and the 2020 RTT end game?

We must remember that RTT is not just an Acute provider headache, but a system-wide issue that needs multi-organisational support. You can’t just rely on managerial tactics and gamesmanship to win the game, you need knowledgeable and trained non-clinical staff to form a solid defence, operational processes, BI solutions and data intelligence forming a strong midfield, some talented clinicians as strikers to put the ball in the back of the net, and a strong bench of external support to fill in any gaps, provide external insights and capacity, and help the starting 11 be the best team they can be!

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