How long does it take to get treated for cancer in the United Kingdom’s National Health Service (NHS)? How long does it take for ambulances to arrive? What about wait times at ED visits?
An article in The Independent answers these questions with statistics from NHS itself. The answer to the above questions, about 1 in 5 people will wait for more than 2 months between being diagnosed with cancer and receiving treatment. Ambulances generally only take 7 minutes for the most severe emergencies but take over 23 minutes for less severe cases. About one in six patients requiring emergency department care will wait more than 4 hours before being treated, admitted, or sent home.
So what is the NHS to do? Set new targets to lower wait times? Well actually they have done the opposite; they are scrapping wait time targets. While this may seem like a perverse response, I am actually supportive of the move. Tracking wait times is important but fixed targets may create perverse incentives. For instance, there may be an incentive to reduce wait times for marginal patients who physicians can move below the target; for patients already past the target, physicians may de-prioritize their wait times. In fact, there is some suggestive evidence for gaming the system:
Around one-fifth of emergency admissions occur in the 10 minutes before the four-hour window would have been breached – suggesting clinical decision making is being sidelined by the limit.
The targets may also reduce staff morale. In short, although reducing wait times in the NHS is important, instituting top-down, overly-simplistic, bureaucratic wait time targets are not the way to go.