Patient Anxiety Rises As NHS Waiting Targets 'Jettisoned In All But Name'

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Unveiling a two-year blueprint for the NHS, chief executive Simon Stevens announced plans to axe the decade-old 18-week waiting target for non-urgent operations, including hip or knee replacements, cataract removal and hernia repair. The proposal is part of what the Guardian has called an ‘ambitious survival plan,’ which prioritises easing the strain on A&E departments, as well as improving access to GPs. However, the Royal College of Surgeons was quick to criticise the NHS of “waving the white flag on the 18-week target,” saying it had been “jettisoned in all but name.” Meanwhile, leader of the BMA Mark Porter has said that “Achieving one delivery promise only by missing another is a textbook example of rationing access to care. It should not be happening in today’s NHS.”

The real losers in this ‘trade-off’ are, of course, the patients. In a health service where tight budgets and over-strained departments lead to a compromised prioritisation of care, all aspects of patient wellbeing - both physical and mental - will be affected. The axed waiting targets for operations are indicative of an entire system under strain, and indeed patients have long voiced concerns about the inordinate impact which prolonged waiting times can have on an individual. Charges have been levelled that outdated, inefficient methods of medical correspondence create a level of damage disproportionate to the scope of the measures which would improve such correspondence. In one patient’s case, he received a ‘snail-mail’ letter one month after surgery, informing him that one of three lumps had not been fully removed. The letter was dated back to 12 days before it was received. A second letter scheduled a further appointment for four weeks time - two weeks after the patient was due to travel to Australia. As this did not leave enough time to schedule an earlier appointment, the patient was simply left hoping that the lump would not become more dangerous during his travels. Clearly, overly lengthy waiting processes may lead to dangerous levels of damage where there is potential for degeneration.

But it’s not just physical degeneration that’s at stake - the stress which waiting places on mental wellbeing is a significant factor, and one which matters irrespective of the magnitude of physical problem. Indeed, it is often those with less to fear who end up worrying all the more, as they are accorded a lower priority of care, and left in the dark: when there is no urgency in treatment, doctors see no general need for haste in passing on information. As the website Access Emergency Medicine states, ‘providers of emergency care can easily become oblivious to the concerns of waiting patients. Waiting seems a normal part of the process.’ In a piece called ‘The Anxiety of Waiting for Test Results,’ The New York Times highlights a couple who underwent routine physicals together. While the husband’s results visibly showed up online as normal, the wife was confronted by an alarming message: Contact Doctor’s Office. Worried, and with a family history of breast cancer, she immediately left four messages for her doctor, but got no response. The next day, she pleaded with the receptionist, who said “I can’t tell you what it says, but I don’t think you should worry.” After three days of worry and now frustration, the results returned: the wife had been diagnosed with vitamin D deficiency.

Again and again, in addition to physical degeneration, a triad of uncertainty, anxiety and stress emerge as the real psychological consequences for waiting patients. But while waiting adds worry to even the most perfunctory routine check-up or non-urgent operation, it can have an even more wide-ranging impact on more vulnerable patients and to the communities they contribute to. Sue Craythorne, part of the older demographic most directly affected by the axed targets, has mourned her prolonged inability to participate in a range of volunteering activities while awaiting a hip replacement. Another worried patient, Alison Watson, lists the increasing number of strained local services - from nature reserves and libraries to food banks - which rely entirely on such volunteers.

Furthermore, the psychological damage caused by prolonged and uncertain wait periods will have the greatest impact on overall quality of life for patients who are already mentally vulnerable. While those seeking gender reassignment surgery have a legal right to be treated within the 18-week target, for many the process can take at least six years. Katherine Rake, the chief executive of watchdog Healthwatch, has said that these patients often face an ‘incredibly troubling’ experience, and that the process takes ‘a considerable part of people’s lives.’ In correspondence with the NHS, Healthwatch points to the lengthy waiting times for assessment and treatment, going on to say that ‘we have heard from patients that they also want to know...what patients can expect from services, how they can make a complaint and, above all, how they can access support – particularly psychological support – as many people are still waiting to progress on the pathway.’ It’s clear, then, that waiting anxiety isn’t always an isolated factor for patients, but has the potential to aggravate pre-existing needs for psychological support throughout medical treatment.

From the perspective of a busy doctor, it’s best practice to deal with the most high-priority patients as needs arise, and to worry less about non-urgent procedures which will eventually be picked up by the system. Days are organised by a succession of diagnoses and treatments - caught up in this sequence of events, it’s easy (and to some extent necessary) to forget about the overhanging needs and worries of absent patients. But for each individual, this overhang or limbo period can affect everything, from mental to physical quality of life, through degeneration, anxiety or other vulnerability. And it’s nothing new that greater quality of care in one public service has knock-on effects in every other area of public society. Waiting between treatments is the hidden dimension of medical process - all the more important, then, to bring it to the fore.