If you’ve visited A&E, tried to see a doctor over the past few months, or are on a waiting list for treatment referrals, you will likely have noticed changes in waiting times and availability.
Recent data shows that only 33%¹ of people can get appointments on the same day, with a staggering 21%² having to wait at least a week or more to see a doctor. This could be one reason behind the total number of A&E attendances in December 2022 increasing by 21.8%³ on December 2021 with more patients presenting to A&E departments with minor conditions.
Unsurprisingly, the NHS is still recovering from the impact of COVID-19 and faces enormous challenges, including record waits in A&E across the country, patients waiting longer than a year for elective treatment at hospitals following increased demand, scaled-down healthcare services during the pandemic and long-term workforce shortages.
In the recent budget announcement, Chancellor Jeremy Hunt promised a further £3.3 billion in NHS funding for each of the next two years. Although this rise may give some hope of seeing significant changes in the NHS, the rising energy prices and inflation will likely consume the majority of the increased budget, leaving little to improve services.
Digging deeper, London-based healthcare management consultancy Acumentice has analysed data and challenges from 2022 and explored approaches the NHS can take to move towards recovery.
Elective Care Waiting Times
Elective care is one of many areas still experiencing long waits. The number of secondary care hospital referrals taking over 52 weeks has increased drastically since Covid. What used to be a waiting list of around four million people pre-Covid has nearly doubled, and where patients would typically wait no longer than a year for treatment is now closer to two in many cases. It’s also important to note that these extensive waiting list figures do not include mental health treatment and only focus on physical care within hospitals. Mental health figures remain woolly and not as easily measurable, but it’s well known those services are just as challenged.
Not only are patients waiting for treatment, but they are also waiting on vital supporting equipment, such as wheelchairs or walking aids, with many having been forced to purchase these items with their own money where they are able to afford them due to extensive waiting times. According to the GP Patient Survey 2022, over a third (35%) of respondents admitted they did not have enough support from local services to manage their condition⁴.
Addressing challenges at a granular level
The cause of these issues is more than just staff numbers and the speed at which they can see patients. However, the workforce crisis and persistent understaffing are becoming ever-growing problems for the NHS. Recent research suggests the NHS in England alone is short of 12,000´ hospital doctors and over 50,000 nurses⁵.
Having said that, other factors are impacting these waits. Each region faces different challenges, suggesting the need for bespoke solutions to help improve the use of data, internal systems and processes, as well as collaboration and interaction across all aspects of the NHS; Primary, Secondary and Community care.
Founder and Managing Director at Acumentice, Karina Malhotra, states: “Creating new systems and processes without a quick solution to poor performance is not going to support NHS recovery in the long term when they are not thought through. We must gather in-depth data to thoroughly evaluate a patient’s journey and identify the points where issues are created in each region at a granular level. No two journeys are the same, so you can’t apply a single size fits all method across each organisation. We must consider all dependencies within a complex system to create an effective solution.
“This can include but is not limited to understanding the demographic and population needs a practice or hospital serves. For example, if a trust is situated in an area where the population is primarily over 50, the health issues it will need to manage are very different to that of an area highly populated with children and the younger generation.”
Prioritising local population needs can make the NHS equipped to deal with changes in requirements. This prioritising should not be based on age or population size but should also consider the areas that are more affected and susceptible to health inequalities.
New solutions to old problems
Changes are being made to the NHS to improve the efficiency of resources. One example is elective orthopaedic centres being set up to take ‘easy cases’ from hospitals with emergency departments. . These optimised centres can improve productivity with doctors performing treatments without the impact of emergencies using GIRFT principles.
Karina adds: “Whilst these new centres help significantly reduce the pressure on hospitals, not enough is being done to use these systems to the best of their capabilities.
“For example, many surgeons are hesitant to share lists and patients with other hospitals, which is only further adding to the long waiting times and other issues. More incentives, such as more funding for areas with increased activity, could help to see a change in collaborative working and improve these problems.”
One step closer to recovery
But other than collaboration and incentives, how else can the NHS get closer to recovery? The answer isn’t as simple as creating more hospitals or a larger workforce. We also need to focus more on getting the most out of existing resources.
Whilst many new, innovative technologies are being brought into the NHS to improve productivity and efficiency, they need to be better integrated into existing solutions and be viewed as part of a bigger picture instead of an isolated system. There also needs to be more cooperation between technologies, and the collected data needs to be used more effectively to help make fundamental changes in the NHS.
Karina explains: “No one can give an accurate estimate of when the NHS will be fully recovered. National recovery targets are currently focused on eliminating 18-month waits by April 2023 and waits of longer than a year by March 2025 for elective care. This is an ambitious target already and therefore recovering to waiting times closer to 18 weeks seem fairly distant at the moment. We also have to consider the current cost of living crisis and strikes and how these issues could create changes to funding or priorities.
“There is some hope around the corner though, as the government is starting to focus on the waiting times crises. It has recently launched an Elective Recovery Taskforce which has been asked to advise the government on where the NHS can utilise extra capacity in the independent sector to treat more patients. This is welcomed by all of us as this should support in the short term in reducing the backlog of waits.
“However, long-term solutions are still needed for the workforce and capital investment challenges that will need to be addressed for genuine recovery. The A&E crisis, which has come to a head during the winter months, needs urgent action but one which is comprehensive and sustainable, including a focus on gaining efficiencies wherever possible and finding areas to reduce waste, whether this is wasted time, staff or equipment.”
“We are stalwart supporters of the NHS and do not doubt that with the right funding and interventions, such a genuine recovery is completely possible. The workforce of the NHS is capable of amazing things – they now just need the support to do so.”