In 2004, the Government set a new target in the NHS Improvement Plan of a maximum waiting time of 18 weeks from the time of referral to a hospital consultant, to the start of treatment.

This period is known as ‘referral to treatment' (RTT) and takes into account the total period of waiting - from initial referral to start of treatment, including any waits for tests and results.

The NHS was initially given until the end of 2008 to achieve this goal. The NHS' operating framework for 2007-08 set two further milestones to be achieved by the end of March 2008:

• 85 per cent of pathways where patients are admitted for hospital treatment should be completed within 18 weeks 
• 90 per cent of pathways that do not end in an admission should be completed within 18 weeks.

The purpose is to ensure patients experience shorter waits for treatment, understand where they are on the pathway and what the next step towards diagnosis or treatment will be.

With better integration and redesign of services, and emphasis on the appropriate use of skills and timely interventions, the benefits for both patients and professionals are apparent. They include: more appropriate contacts, increased communication, better quality of referrals and increased job satisfaction.

The national policy on and support for achieving the 18-week target is set out on the 18 weeks website.

If you are interested in working with the Improvement Foundation please go to How we can help or click here to contact us.

Who is involved

The Improvement Foundation is currently supporting PCTs and working with clinicians, managers and service users to gain a better understanding of the service redesign required for commissioners to achieve 18-week care pathways.

What we are doing

Delivering the 18-week target requires fundamental service transformation - doing the same things faster will not achieve the target.

Further, delivering 18-week pathways for patients is clearly different to previous targets. There is a shift from focusing on stages of treatment to whole pathways, and from small, service-focused improvements to whole pathway transformation across organisational boundaries.

There are a number of service improvement tools and techniques that can improve efficiency, drive quality and aid the delivery of 18 weeks. However service improvement alone will not be enough as there is a need to ensure the NHS is able to both deliver and sustain 18 weeks and this requires a real transformation of services. Service transformation is dependent not just on influencing processes, but also on changing mindsets, cultures, activities and organisational powerbases.

We are bringing all stakeholders together to address the key issues and develop joint action plans that cross the boundaries of primary, secondary and social care.

A mutual understanding of the key priorities is essential and a strong working relationship between primary and secondary care is crucial to the implementation of changes that will end waiting and improve patient care.

There are some excellent examples of care pathway redesign that have dramatically reduced waiting times, while improving the quality of care and patient experience. New, innovative ways of working - bringing together hospital and primary care nurses and allied health professionals, for instance - to deliver improved services are being used.

Any of the mechanisms to achieve 18 weeks also potentially give a savings benefit to practice based commissioners. Service redesign can transform care pathways, enabling care to be delivered more locally and release capacity of specialists in secondary care to enable more complex cases to be treated faster.

Managers and clinicians working with the Improvement Foundation on the Practice Based Commissioning Development Programme are learning from these examples and are adapting models of care to fit with local priorities. The Improvement Foundation facilitates and supports the cooperation and the inter-organisational working that is fundamental to achieving the 18-week target.