Patients in England are experiencing prolonged periods of pain and discomfort as more than half of the nation's health boards have implemented minimum waiting times for elective surgeries, according to a study published in The British Medical Journal. These mandated delays, ranging up to 16 weeks for procedures such as hip, knee, and cataract surgery, are reportedly being used as a cost-control measure, even when hospital capacity exists to treat patients sooner.
The investigation, which utilized the Freedom of Information Act, surveyed 35 of 36 integrated care boards (ICBs) in England. Of those, 17 confirmed the enforcement of minimum waiting periods for key procedures. Some boards, like Shropshire, Telford and Wrekin, and West Yorkshire, have set a 16-week minimum for all routine procedures. West Yorkshire stated its target was for 90% of patients to wait at least 16 weeks, also noting this provides flexibility to prioritize patients at risk of clinical deterioration.
Shropshire cited a 16-week minimum threshold to "promote fairness, reduce variation, and ensure that all patients receive timely and equitable access to elective services." Other areas have introduced similar minimums for specific treatments, such as cataract surgery, or operate under "planning assumptions" of several months' wait. Birmingham, for instance, has a 14-week minimum wait for planned elective care unless clinical urgency is demonstrated. Humber and North Yorkshire, NHS Hereford and Worcestershire, Dorset, and Somerset also indicated minimum waiting times in their planning or contractual assumptions, generally between 14 and 16 weeks for routine procedures.
Professional bodies have raised concerns about the practice. The Royal College of Surgeons stated that patients should be treated as quickly as possible, warning that unnecessary delays can worsen pain, reduce mobility, increase anxiety, and allow conditions to deteriorate. Tim Lane, president of the Royal College of Surgeons, noted that access to treatment should be based on clinical need, not location, and that minimum waits do not address underlying capacity issues within the NHS. He called for increased investment, improved infrastructure, and better utilization of existing capacity.
Similarly, Professor Victoria Tzortziou Brown, president of the Royal College of GPs, described the long waits as frustrating for patients and adding pressure to general practice. She stated that blanket minimum waiting times for administrative or financial reasons are difficult to justify, especially when patients could be treated sooner. She emphasized that treatment decisions should be based on clinical needs.
A spokesperson for the NHS acknowledged that commissioned wait policies can aid in making the best use of services, staff, and budgets, but asserted that all patients are seen in order of clinical need. The NHS also stated it would not expect any organization to commission waits that risk breaching the NHS Constitution standards, which set a maximum 18-week wait for elective treatment. Sally Gainsbury, a senior policy analyst at the Nuffield Trust, suggested that limiting activity with minimum waiting times could be a rational response to budget distribution but expressed concern about the fairness and clarity of such policies.
