NHS waits: Getting the excuses in early?

Inside an operating theatre Image copyright Getty Images

The devil - as always - is in the detail.

The pledge by Health Secretary Jeremy Hunt to end year-long waits for routine treatment seems to make perfect sense.

After all, the NHS has already made great strides on this issue.

Three years ago the numbers of patients waiting over 52 weeks were hovering around the 20,000 mark. Now there are fewer than 600.

So what could be wrong with the health secretary giving the NHS a last little shove over the line?

Nothing, of course. But it is important to see this in context of the wider pressures on the system.

While the number of patients facing long waits has dropped significantly since 2011 - when ministers first ordered action - there are signs the tide has begun to turn.

The numbers facing long waits have actually started to creep up in the past year or so.

In May last year 434 people had been waiting for 52 weeks, compared to 574 in May this year.

There is a similar story for those waiting over half a year. A year ago it stood at 51,562, but now it is 65,394.

In fact, whichever way you slice the waiting time figures there are warning signs.

The numbers on the waiting list overall (once you add those waiting over 18 weeks to those who are still within deadline) have been going up.

This year they have topped 3m for the first time in six years.

Image copyright Science Photo Library
Image caption More are waiting longer than four hours in A&E

The average wait for treatment has also been high in recent months - and in February hit its highest level since the 18-week target was introduced.

While this has been going on, the NHS has still managed to keep to its official target.

That is measured not by the numbers on the waiting list or the average wait, but by the proportion of patients seen within 18 weeks.

For patients who need to be admitted - those undergoing hip and knee replacements, for example - the NHS has to see 90% in 18 weeks.

Apart for February and March when it was missed ever so slightly, the 90% target has been met this year - as it has for most of the time since it came into place under Labour.

But within the health service it has been widely acknowledged that this achievement - met despite the squeeze on spending and rising demands - could only be maintained for so long.

That threat - I am told - has been causing a lot of angst at the Department of Health.

So the acknowledgement that the 18-week target will be missed in the coming months in a "managed breach" is a critical detail.

This is unheard of. The 18-week target is enshrined in the NHS Constitution and was personally committed to by the prime minister in June 2011 when the controversy over the government's NHS reforms were at their peak.

What is more, the big improvements made from late 2011 through to early 2013 when the number of year-long waits fell 40-fold did not lead to a breach in the 18-week target.

Instead, by making it clear the target is going to be missed at this stage and pinning it to the desire to tackle long waits the government - it could be said - has got its excuses in early.