A foundation trust in Somerset appears to have discovered how to crack the problem of NHS waiting lists. If all goes according to plan, every patient attending Yeovil district hospital will be treated within 18 weeks of being referred there by a GP. The trust's clinicians expect to achieve that goal by the end of March.
By NHS standards, 18 weeks is extremely fast. With a supreme effort, hospitals across England managed by the end of last year to bring the maximum wait for an outpatient appointment - the first stage of the patient journey - down to 13 weeks. But patients could then wait months, or even years, for diagnostic tests to be carried out before a consultant decides to put them on the waiting list for an operation.
When Labour came to power in 1997, that final stage of waiting could last 18 months or more, but the government poured massive resources into shortening it to the current maximum of six months. Labour's manifesto at the last election promised to telescope the entire patient journey, from GP referral to being wheeled into the operating theatre, into a maximum of 18 weeks, with average waits a lot less.
The prime minister, Tony Blair, has asked to be briefed by the Department of Health next week about how the NHS is gearing up to deliver. He will hear that the service carries out more than 3m diagnostic tests each year - such as MRI scans, endoscopies, barium enemas and non-obstetric ultrasound. There are plans to increase capacity to reduce the "hidden waits" between the outpatient and inpatient queues. But the NHS has a mountain to climb to achieve the 18-week maximum. A survey of one unnamed trust showed a quarter of orthopaedic patients waited more than a year to reach the operating theatre. Such delays are not going to disappear in a hurry.
So the story of what the Yeovil trust has achieved - on its own initiative without extra funding from the government - is hugely important for the NHS as a whole. The trust realised towards the end of last year that a lot of the work it was doing to improve the quality of patient care also reduced delays in treatment. In many medical specialisms, the traditional patient journey did not make much sense. Was it really necessary to ask patients to wait months for an outpatient appointment before telling them to join another long queue for diagnostic tests?
Wouldn't it be smarter to set up a system to help GPs book the right tests so results would be available at the time of the first outpatient appointment? Why not set up one-stop clinics in the hospital so that patients could have the tests in the morning and an outpatient consultation in the afternoon?
The Yeovil trust is changing its procedures to reduce the number of journeys patients have to make to hospital. In the gastroenterology department, for example, consultant Jim Gotto is working with local GPs to establish diagnostic protocols. If they think a patient needs an endoscopy (an internal examination using fibre-optic technology), they will explain why in the referral letter and send diagnostic data to back up their judgment.
The protocols have helped doctors at the hospital to plan their work more efficiently. Gotto expects to reduce the maximum outpatient wait to 11 weeks, leaving enough time to complete treatment within 18 weeks of GP referral.
In each of the hospital's departments, the reforms are being led by clinicians, working out their own best practice. The cardiology department aims to bring the outpatient wait down to nine weeks, and in orthopaedics the target is six.
The radiologists have helped by changing their rosters. They found they could see 20 more patients every week at no extra cost by working four long days instead of five shorter ones.
James Scott, the chief executive, says the trust had a long track record of reducing waiting times. It was one of the first to meet the six-month target for an operation. "For some specialities, achieving the 18-week maximum is a small step. For others it is a bit of a stride, but none have to make a great leap," he says.
Yeovil might also have an advantage in being a relatively small hospital: it employs 1,700 staff and spent £83m last year, serving a population of about 180,000, mostly in Dorset and Somerset.
Patient pathways
Scott says: "A trust that is three or four times our size might have to break its operations down into smaller business units to focus on the patient pathways. But there is nothing intrinsically different about Yeovil. We are creating a self-improving organisation where clinicians are aligned to corporate goals and innovate without me having to tell them to innovate."
The trust plans to spend a little extra on diagnostics and is appointing a few more specialists, but for the most part the secret of shorter waiting times is "working smarter rather than working harder".
But could Yeovil's success be its undoing? What happens if patients from further afield choose to travel for quicker treatment in Somerset? Scott hopes he has procedures in place to increase capacity in response to demand - but he admits he can't guarantee it.
The Yeovil story may sound encouraging to Blair, but officials should warn him that the hard part will be replicating the innovative enthusiasm of its clinicians.
