Increasing numbers of patients removed from reported waiting list

NHS England has confirmed that there were 3911 instances of patients being removed from the reported waiting list and placed on active monitoring between December 2022 and November 2023.

Guidance introduced in October 2022 permits clinicians to remove patients from the NHS elective waiting list after they have declined two offers of treatment and place them on ‘active monitoring.’

While NHS England has highlighted that moving patients onto active monitoring is a clinical decision and guided by patient choice, critics of the guidance have highlighted the potential for patients to be pressured off the reported waiting list.

Concerns have also been raised about the level of patient choice that is present within the guidance – for example, if a patient is repeatedly offered an appointment at a location they cannot reach.

The number of patients placed on active monitoring is increasing. A Freedom of Information Act request by Optometry Today revealed that between December 2022 and May 2023, an average of 247 patients were placed on active monitoring each month.

This figure increased to an average of 404 patients each month between June 2023 and November 2023.

NHS England highlighted that patients may be counted more than once in the data provided. For example, a patient may go onto active monitoring one month, before returning to the reported waiting list and then again being placed on active monitoring at a later date.

“Those requesting to be placed on active monitoring for choice reasons constitute 0.59% of the waiting list,” a spokesperson shared.

An “alarming” trend

Referral to treatment expert, Karen Hyde, questioned the degree of patient choice that is present if a patient is offered two appointments at a location they cannot reach before being placed on active monitoring.

“The majority of ophthalmology patients are elderly and don't want to travel. How is that patient choice?” Hyde emphasised.

When asked for examples of the appropriate use of active monitoring, Hyde shared that a patient may need to lose weight or stop smoking before surgery can be undertaken.

Young patients may need to reach a certain weight or age before treatment can begin.

However, Hyde has also been made aware of times when active monitoring has been used inappropriately – for example, because of capacity issues or long waiting lists for an MRI.

Hyde, who is a consultant for data and elective pathway management company, Insource, also emphasised the importance of patients receiving regular clinical reviews while under active monitoring.

“Without clinical review and looking at the number of people that this affects, there is the possibility that patients could come to clinical harm,” she said.

Although patients on active monitoring are required to have a clinical review every three months, Hyde shared that there was no mechanism for monitoring or reporting this.

Dr Peter Hampson, clinical and professional director at the AOP, described the increasing numbers of patients being removed from the reported waiting list as “alarming.”

“The nature in which waiting list data is reported makes it difficult to get a whole system perspective on the situation and this new categorisation of ‘active monitoring’ raises further challenges,” he said.

“We know that many patients are finding care and treatment difficult to access due to the backlog, and the concern is that patients who may be placed on ‘active monitoring’ through no fault or choice of their own may not be aware what this means for them,” Hampson highlighted.

“With the majority of ophthalmology patients being elderly, and their mobility often being limited, in conjunction with diseases such as glaucoma being difficult to self-monitor, we are concerned that some patients may come to harm. Rather than arbitrarily moving patients to ‘active monitoring’ it would make far more sense to monitor these patients in optometric practices, where they can receive the expert care they deserve,” he emphasised.