Peter Moore: The truth behind NHS waiting list ‘reductions’

Recently there was rejoicing. NHS waiting lists are down 86,000. The bad news: these figures are a bit dubious.

Managers had trawled though the waiting lists and taken out anyone who no longer needed to be seen. This included the reasonable excuse that they died waiting. 

I was shocked to find out that there still people out there who take NHS statistics seriously. In the fifty years since I qualified, I have never taken any NHS statistic at face value. Of course they are all manipulated. This should be no more of a surprise than to find potholes in Torbay.

It is not the first time this trick has been used to massage waiting lists. Back in the 1980s the waiting list for cataract surgery was reduced after a review. This was claimed as a success story without mentioning that the list had been reduced by removing people who died waiting. 

In my first job after I qualified, which was not in Torbay, I was a member of one of the two cardiac arrests teams in the hospital. The management published a statistic showing that we had a success rate of over 70%. Unless the other team were achieving 100% and there were a few miracles raising people from the dead these figures seemed a little dubious.

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I read the report in detail. It turned out that their definition of success was getting the heart rate back to normal. If we managed to get the heart back three times before the patient died without regaining consciousness that was, in their book, a 75% success. I am not sure that the grieving families would agree. 

A previous Government was criticised as there were too many managers and not enough nurses. This was easily fixed by reclassifying all the nurse managers from managers to nurses. Suddenly the Government could announce a large reduction in managers and an increase in nurses. No one seemed to notice that it was the same people doing the same job. 

When one of our sons broke his toe playing football I took him to the A&E department. We were met at the door by a nurse who looked at his foot and said we would have to wait at least two hours. The A&E department proudly claimed that all patients were seen by a health care professional within twenty minutes. This was true but they failed to mention that the health care professional was telling everyone how many hours they would have to wait. 

One GP practice was the pride of the trust. By working as a team they had half the number of orthopaedic referrals compared with other Torbay practices. If this work could be duplicated the trust could dramatically cut the orthopaedic waiting list, except that there was another explanation. 

One of the GPs involved confessed to me that, as the practice was between Torbay and Plymouth, half their referrals went to Plymouth.  The trust were only looking at referrals to Torbay. If they had included all the orthopaedic referrals to Plymouth as well as Torbay they would have found that this practice had almost the same referral rate as the rest of South Devon. 

I have a personal confession. One winter I was very busy with one doctor down when I was asked to produce all the statistics on our diabetic patients. This was before we computerised and the search would have been very time consuming.

Seeing patients was a better use of my time. Eventually, I gave in and sent all the figures requested but underneath my charts I admitted that I had invented all the figures. I am not sure anyone noticed my confession but they published my creative figures in the annual report. 

The problem with setting any target is that the system is then redesigned to hit the target rather than provide care. They lose sight of the bigger picture.  

Will there be another shocking news story next week: something no one suspects? Maybe it will leak out that Paddington is not a real bear. This should be as much of a shock as realising that published NHS statistics may need a little interpretation.

The NHS does not recommend too much salt as it increases the blood pressure, but a pinch of salt might be healthy when reading their statistics.