Journal Article

Effect of cancer waiting time standards in the English National Health Service: a threshold analysis

Lilford, Richard, Bird, Paul, Quinn, Laura

2024

Overview

Background The English National Health Service has multiple waiting time standards relating to cancer diagnosis and treatment. Targets can have unintended effects, such as prioritisation based on targets instead of clinical need. In this case, a `threshold effect’ will appear as a spike in hospitals just meeting the target. Methods We conducted a retrospective study of publicly available cancer waiting time data, including a 2-week wait for a specialist appointment, a 31-day decision to first treatment and a 62-day referral to treatment standard that attracted a financial penalty. We examined the performance of hospital trusts against these targets by financial year to look for threshold effects, using Cattaneo et al. manipulation density test. Results Trust performance against cancer waiting targets declined over time, and this trend accelerated since the start of the Covid-19 pandemic. Statistical evidence of a threshold effect for the 2-week and 31-day standard was only present in a few years. However, there was strong statistical evidence of a threshold effect for the 62-day standard across all financial years ( p  < 0.01). Conclusion The data suggests that the effect of threshold targets alters hospital behaviour at target levels but does not do so equally for all standards. Evidence of threshold effects for the 62-day standard was particularly strong, possibly due to some combination of a smaller volume of eligible patients, a larger penalty, multiple waypoints where hospitals can intervene, baseline performance against the target and where the target is set (i.e. how much headroom is available). RCTs of the use of threshold targets and of different designs for such targets in the future would be extremely informative.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Analysis / Cancer / Cancer care / Care and treatment / Confidence intervals / COVID-19 / COVID-19 - epidemiology / Diagnosis / England / Estimates / Health Administration / Health Informatics / Health services / Hospitals / Humans / Hypotheses / Management / Medical appointments and schedules / Medical care / Medical diagnosis / Medical screening / Medicine / Medicine & Public Health / Neoplasms - therapy / Nursing Research / Pandemics / Patients / Public Health / Qualitative research / Quality management / Referral and Consultation - standards / Retrospective Studies / SARS-CoV-2 / Socialized medicine / State Medicine / Threshold analysis / Time-to-Treatment - standards / United Kingdom / Waiting Lists / Waiting time standards