What levers were used to cut NHS waiting times between 2001-2010?

In his May 2023 mission statement on health and the NHS, Keir Starmer – as leader of the Labour Party – committed the next Labour Government to reduce long waiting times, culminating in reaching the targets met by the previous Labour Government in 2010.

This is an important commitment for the Labour Party – and of course the NHS. But, more than this, it is vital to the rebuilding of trust between public and Government. The public consistently put the NHS amongst their top concerns. Similarly, because of this anxiety, they have major concerns about long waits. A political party that is elected on the promise of reducing NHS waiting times that fails to deliver them doesn’t just cause more people to wait a long time for treatment, it also loses a bit more trust between the public and Government.

On the morning of the mission launch Keir Starmer, when interviewed for the Today programme, was asked about this promise. It was pointed out to him that his timescale for reducing waiting times to 18 weeks promised, in just five years, to do this at a quicker pace than Tony Blair’s government.

Given how important this issue is to the public, the NHS, and to our political future, I thought it might be useful to run through an understanding of what was achieved between 2001 and 2010 and compare that with what needs to be achieved between 2024 and 2029.

I am pretty certain that we will be returning to this topic over the coming year, but let’s start with the broad outlines of what New Labour did in 2001-2010.

In December 2022 the King’s Fund published a report, “Strategies to Reduce Waiting Times for Elective Care” –  a worthwhile read on the topic. My take on it is not exactly the same – but not that different either.

The first thing to note are the dates I use. New Labour won its first term in 1997. Famously the pledge card for that election promised to reduce the numbers on the NHS waiting list. I’m sure this felt like the target, but what we now know is that people do not mind being in a waiting list queue  as long as it’s a short one. It became clear that what really worried the public was the length of the wait, not the length of the list. By 2000 NHS Plan clearly identified the length of time spent waiting as the main public concern.  Consequently the 2001 Labour manifesto pledged to reduce long waits (and the 2005 manifesto added further pledges).

If the Labour Party win in 2024 they will not have the luxury of having five years to reconsider their policy aims. They will have to deliver results in their first five years. They will have to start at speed – and then accelerate.

My second point is that from 2001 to late 2002 (again -for full disclosure – I was working as a SPAD for the then Secretary of State Alan Milburn  at the time) most of the organisational and medical leadership of the NHS disagreed with having cutting long waits as a goal. This was variously described as taking clinical decisions away from clinicians; as a political set of goals; and, most importantly, as simply not possible. Before the NHS could play its essential role in reducing long waits it had to believe strongly that this was an important and achievable goal for its work.

Over that year the Government deployed the argument that since it was the length of waiting times that were of the greatest concern to the public it would work with the NHS to bring them down. The Prime Minister, Secretary of State and other Ministers made regular speeches on the subject. Having been elected on a manifesto that included such pledges, it was vital that the Government represented (and won) that argument on behalf of the electorate.

So it was true that, insofar as they were the result of an election, they were politically motivated goals because, within the structure of the NHS, electoral politics was the only means by which the public could make their voice heard.

I doubt there will be much argument about the importance of reducing long waits if Labour win in 2024. The NHS understands its importance to the public. The main argument will, once again, be about the possibility of delivering it. By 2024 morale will be even lower and there will be little belief in the possibility of making something so very difficult happen. And a policy that sounds like telling everybody just to work harder will make matters worse. What we learned in 2001 will have to be repeated in 2024 – this is long-term politics. Long waits will not be reduced in a few months. It took and will take time, and increased activity will build over 5 years – not 5 weeks or months.

I recently re-read the 2000 NHS plan. It’s clear that there were five major sets of reform levers which, along with the increased resources, played a big part in reducing long waits.

• • In 2002 we introduced a policy of giving those organisations that did more work, more resources for doing it.
  • In the same year we introduced patient choice for those waiting for more than 6 months
  • As I outlined in last week’s post the Government created a new set of independent sector providers which brought in staff and methodologies from abroad. This not only added capacity but importantly demonstrated to the NHS how activities could be carried out safely – and usually with greater productivity.
  • We created some autonomy for the better performing trusts through the Foundation Trusts initiative.
  • We started the process of quality differentiation which has now become the Care Quality Commission (CQC).

The result of using these levers was to reduce long waits.

“By December 2008 it was evident that the 18-week target had been convincingly delivered; 96.8 of non-admitted elective patients and 90.3 % of admitted elective care patients were seen within 18 weeks. By 2009 the median wait for treatment was 5 weeks”

Strategies to reduce Waiting Times  – Outcomes of actions taken

Later this week I’ll look at how the arguments for these levers were developed.