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The paper by Policy Exchange concludes that the current state of the referral-to-treatment waiting list in England, which now stands at more than 5.3 million people, is unacceptable. With an uncertain winter ahead and one in ten people already waiting for an elective procedure, the issue is now urgent.
There are concerns both over physical capacity and staffing. Apart from its effect on waiting lists, the pandemic has created new demands for both acute and long-term care; and the tighter infection control protocols have made it more difficult to catch up. Another key concern is that there are significant divides across the country in terms of the size of waiting list and the rate of recovery, as well as access to high-performance services.
Key actions in the Policy Exchange paper include working smarter and rethinking care pathways, improving access to diagnostics, expanding surgical hubs, extending the use of new technology and data, and significantly increasing capital investment.
It makes the important point that patients are often kept in the dark about how long their wait might be. This uncertainty can lead to unnecessary stress, anxiety and a greater strain on patients mental health. Out of the current waiting list, more than 80% are awaiting a decision on treatment, representing an unknown clinical risk for the NHS that is even greater than long waiters. As well as more accurate forecasting and planning of capacity with built-in flexibility, greater transparency and communication with patients is needed.
We do not yet know what the ultimate impact of the pandemic on elective waiting lists will be. The number of patients waiting is widely expected to continue to grow over the next 12 months as at least a proportion of the 7.5 million people who did not seek treatment during the pandemic turn into referrals. As the report states, even optimistic scenarios have forecast a waiting list approaching 8 million people by December 2021, which will take between five and nine years to be fully addressed.
To get a head start on recovery, all capacity that can be made available should be used. Increasing patient throughput may mean expanding the surgical hubs concept for specialisms with long waiting lists such as ophthalmology and orthopaedics, creating diagnostic hubs, establishing more dedicated ‘green’ sites with lower Covid-19 risk to protect elective activity, and utilising independent sector capacity more effectively.
The challenge is to increase resilience within the system so that prioritising elective care does not have a negative impact on other parts of the NHS. This can be achieved with flexible healthcare solutions, such as modular and mobile operating theatres or procedure rooms, which can boost capacity substantially on a temporary or semi-permanent basis. Such facilities can be combined to form a complete, standalone diagnostic or surgical hub to the Trust’s own specifications.
This was the case during a recent Vanguard project in south west London that was covered by both ITV and BBC News. In just four months, we designed, developed and delivered a surgical hub that has enabled the NHS to substantially increase elective care activity in the area. The complex includes 4 operating theatres and all the supporting areas to provide safe patient care, providing the capacity to deliver an additional 120 operations per week.
Addressing the waiting list is now urgent and must be made a priority to avoid the number of people waiting escalating to unmanageable levels. As well as the clear impact on patient’s lives, failing to make headway on the backlog can also lead to higher emergency admissions, and increased pressure on mental health and primary care, placing additional burden on many areas of the NHS. Get in touch now to discuss how Vanguard can help with your capacity needs.
The paper by Policy Exchange can be downloaded here.