Outside the marginals

a commentary on the politics that followed the UK 2010 & 2015 elections

NHS Waiting Times – Why?

I have to admit that I am a bit mystified by the current debate on NHS waiting times.

A re-think is needed on the waiting time target for routine operations as 18 weeks is too long for some patients, the new leader of UK surgeons says.
BBC News Website 10 July 2014 : Call to review waiting times for routine surgery

Maybe it’s because I have worked in manufacturing operations, but I do not understand the need for such excessive waiting times.

The preliminary “work content” of a medical operation (from diagnosis of need to actual operation) has to be relatively small – certainly not 18 weeks of “work content”. There may be a need for some further diagnostic tests (x-rays or similar – a few tens of minutes, certainly less than an hour “work content”), in some cases there may be some preparation work (bespoking an artificial joint – possibly a few days, or planning a complex operation – possibly a few hours) and preparing the patient (excluding where the patient needs to lose weight or something similar, the need is a few hours to ensure the patient’s condition has not changed and is fit enough for surgery and to be “Nil by mouthed” and anaesthetised). Some of these activities can overlap. Then there is the actual theatre time. Recovery and post op time does not form part of the overall “waiting time” experienced by the patient – but may be a constraint.

The rest is what in manufacturing we would call queuing time – essentially non-value-added.

If the queue is not getting longer, that would indicate that the resources available are sufficient for the demand. If demand was too high, the queue would extend. Often there is surplus resource in places because if you closely examine the whole process you find that it is constrained at one particular point. The theory of constraint management then says that you concentrate on making maximum use of this bottleneck resource and improving its efficiency. If you are successful in doing this it will cease to be a bottleneck and the constraint moves to another part of the process. You then switch your focus onto the new constraint.

So given that the queue is essentially reasonably stable, why do people have to suffer such waits? In theory a bit of extra temporary resource – say six-day working rather than five (assuming this is not already being done) which would give 20% extra capacity – should work the wait down to a “minimum acceptable wait” for the patient. Except in emergencies patients probably want a slight delay between diagnosis and operation, but this is unlikely to be more than say a couple of weeks – which surely is also enough time for any preliminaries.

(If this seems counter-intuitive, consider a thought experiment. Suppose that overnight 16 out of every 18 people on the waiting list died (or miraculously recovered). Your average 18 week waiting list will instantly shrink to an average of 2 weeks. Why should the waiting list then extend back out to 18 weeks – given that we have established that the relative stability of the waiting list indicates that there is enough resource to cope with the demand?)

Perhaps some medic reading this can offer some explanation as to why so much waiting and queuing time is required – possibly in the form of a gantt chart identifying value-added time and non-value-added time and indicating where the constraint typically is.


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One thought on “NHS Waiting Times – Why?

  1. Peter on said:

    I’ve often wondered the same myself. It’s as if there has been a permanent waiting time built into the process that has remained with us since the dark ages.

    There’s also the issue of how long patients wait once they have attended their appointment. The NHS has had almost 70 years to be able to work out how long a typical day’s appointments take, and factor in the average number of people who don’t turn up, and those who arrive late, yet a wait of 90 minutes before being seen seems to be not uncommon. Has the administration learned nothing from the past?

    Of course the outpatients departments have worked out a way of not showing this in statistics by calling the patient in almost immediately, weighing them and then leaving them for a long wait, and can therefore ‘prove’ that all patients are seen within 10 minutes.

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