Once a patient has been referred to a Hospital for non-urgent, Consultant-led treatment the 18 Week RTT pathway starts and the clock is ticking. Executive Directors have the ultimate responsibility for making sure that the Hospital has the right staff and the right processes and procedures to deliver patient outcomes within 18 Weeks.

There are usually three divisions within a Hospital - Surgery and Anaesthesia, Medicine and Women's & Children. Each division within the Hospital should track every patient from the start of their referral, up to and including the end of the referral and for any appointments that occur once the 18 Week clock has stopped. Divisions will be responsible for making sure they have enough staff of the right caliber, enough clinic sessions of the correct length of time, enough theatre sessions of the correct length of time, that staff understand the RTT rules and codes and how to apply them correctly and most importantly how to remove all obstacles that could cause delays to patient pathways.

Each division should scrutinise their Patient Tracking List (PTL) at least once a week, to analyse each patient pathway to ensure that all patients will be treated within 18 Weeks from start of referral. Management within the Hospital should hold the divisions accountable for reporting any potential issues and solutions.

90% of patients admitted to Hospital should have a Referral to Treatment period of less than 18 Weeks from receipt of referral. Prior to 2008, patients were waiting unnecessary lengths of time for their treatment. For example a patient who required a new hip may have been on a waiting list for three years and more before they received their treatment. The reason for this was because there was no emphasis on booking patients in chronological order of their referral or clinical urgency which includes patients with suspected Cancer or those who require an urgent appointment.  The Government decided that 90% of all patients whose treatment requires either a day case or longer in Hospital must be treated within 18 Weeks of their referral date. An 18 Week RTT pathway is completed on the day the patient is admitted for the first definitive treatment or is discharged from the care of the Hospital. n.b. this Standard is going to be removed from the Rules and we will update the website to reflect this when it is appropriate to do so. 

There are two aspects of the Admitted standards; Adjusted - Once a decision to admit a patient for treatment has been made but the patient wishes to take a holiday or wait for other social reasons, the Hospital can pause the ticking clock until the patient is ready. The Hospital can remove the length of the pause from the overall waiting time for their reports. Non-adjusted - The duration of the patients pathway (from clock start to clock stop), disregarding any pause adjustments. NHS England robustly monitors the volume of patients waiting over 52 weeks.