Choice

I attended a patient forum meeting last night at my local hospital. During his talk the Medical Director told us a joke that he said was prevalent in the NHS of the 80s:

Receptionist: We can give you a date for your hip replacement: it will be 10:30am on June 22nd, 2015
Patient: Sorry, but I cannot make that appointment. The Gas Board is coming to install my cooker at 11 on that day.

Well, I guess the humour is all in the delivery. The point was to illustrate the "Soviet-style" of public services in the 80s: we were just too amenable to waiting long times.

Things have changed now, of course. The NHS constitution says that we have to be treated within 18 weeks and as David Cameron has found, there is a political cost to allowing waiting times to go up.

The 18 week RTT target was politically concocted, there is no special meaning to 4.5 months. (In Denmark, for example, the waiting time has to be less than 1 month.) Anyone who has been on a waiting list will tell you that it is not necessarily the amount of time that is the issue, it is the uncertainty of not knowing when you'll get the treatment. The uncertainty is especially acute if the patient is worried about the treatment.

Cutting waiting lists is expensive, so it is unlikely that any political party will promise to cut the (arbitrary) 18 week target. However, there is another policy that could be offered. Patients could be given one of two choices: treatment within 18 weeks, but the date is determined by the provider (the situation at the moment); or treatment on a date of the patient's choosing as long as it is outside the 18 week window (the actual limit may be different to 18 weeks). The idea would be to guarantee (as much it is possible to guarantee) that a patient will get the treatment on the day that is specified by the patient. This means that the patient will know that their cataracts will be replaced before they go on their birdwatching holiday, or their hip will be replaced before their child's wedding. There will be still work for NHS providers to so: they will have to have the capacity so that patients on the 18 week guarantee will fill the "gaps" between the patients who have booked.

So the joke would be partially true, patients may recieve treatment many months in the future, but the difference would be that they choose to have their treatment on that date. I think that this could be a popular policy at the next election.