Beyond healthcare

The NHS waiting list crisis

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waiting

for treatment

is linked to increased anxiety & worse

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Waiting for change: The NHS Waiting List Crisis

Summary

What if we told you that one in ten people is currently sitting on the NHS waiting list? That’s over 7 million people. It’s 10% of the UK’s population. A queue of them would stretch from John O’Groats to Land’s End and back, twice.

Whichever way you express it, that’s 7 million people each with their own story, their own anxieties and fears, their own worsening health challenges. Fixing this is a mammoth job.

What are they?

These are made up of people waiting to start treatment in a hospital. From the moment your GP refers you, until the moment you start treatment,
the clock is ticking.

Why are they important?

Reduction of NHS waiting lists is one of the 5 key priorities of the government. In this article we’ll try and make sense of some of key numbers and some of the new initiatives, including the launch of 
‘Patient Choice’. 

10 Downing Street invited Dr Tal Mahmud to meet the Prime Minister, Rishi Sunak, ahead of the policy launch of Patient Choice – an initiative for GPs to refer patients to a minimum 5 hospitals anywhere in the country.

Patients will be able able to choose and manage their appointments. This could reduce the waiting list by 3 months.

How’s it going?

In February 2022, NHS England produced its ‘Delivery plan for tackling the COVID-19 backlog of elective care’. Its key targets, by March 2025 were to (i) reduce waits to less than 1 year and (ii) increase NHS activity by 30% above pre-pandemic levels. So, what has happened one year on from setting those ambitious targets? The Institute of Fiscal Studies (IFS) investigated in ‘One year on from the backlog recovery plan: what next for NHS waiting lists?’ 

so let’s take a look at what it found.

In the past year

Over the past year the NHS has reached one of its targets: it has virtually eliminated the 2 year+ wait. That made up some 70,000 patients, a figure which has dropped by over 90%.

However, what about the other targets? What about those waiting over a year? Well there’s still a huge amount of work to do to reach that target by 2025 and it involves treating over 360,000 patients.

Reduction in activity

Not such a good start on increasing activity though. Despite the NHS’s target of a 30% increase above pre-pandemic levels (comprising around 21% increase in elective activity and an 8% increase in the ‘Advice and Guidance’ service, where GPs seek advice on further management or referrals from a consultant colleague), elective activity in fact decreased in 2022 by 8%, compared to 2019.

That’s a shocker of a start to such a meaty ambition. We need to improve processes, people and premises in order to be able to make a dent in that targ

Advice and Guidance
has had good traction with over 66% of referrals not needed

If ‘missing patients’ have already been treated, the target could be more achievable

Advice and guidance.

One thing that has gone well is the use of the ‘Advice and Guidance’ service.  In the 12 months to March 2023, there have been 2.7 million uses of the service given by consultants to GPs.

Geography and specialty vary widely, but as a result, over 66% of referrals were not needed, and where a referral was made, management plans were initiated while waiting. 

The missing millions

As we all know referrals to secondary care during the pandemic nosedived. Estimates are that between 7 and 10 million of them dropped off. And to date the referral rates don’t reflect this additional demand.

Some of the initial forecasts estimated a waiting list of 13 million people, yet demand is flat-lining – weird as we’d expect higher demand from our growing and ageing population.

Does that mean that there are undiagnosed people, which would result in an increase in illness in the long term? It is hard to count something that hasn’t happened. Perhaps the additional demand has been met by urgent care services, or the ‘Advice and Guidance’ service? The IFS factored into its forecasts for missing millions to come back into the system over a period of 30 months.

If that demand does not happen, then there is a chance that the waiting list will reduce at a quicker rate than currently forecast. 

2 year wait achieved, but still 360,000 patients waiting over 1 year

Activity forecast to increase by 30%, however, it decreased by 8% in 2022

Clinicians

Recruitment and retention is a huge problem in the NHS. The vacancy rate is at an all time high at 130k posts or 10% of the workforce. The current strikes are likely to have a negative impact waiting list, however, that has not yet materialised yet.

However, there are more clinicians. In hospitals there are 21% more doctors and 16% more nurses than 5 years ago.

In primary care (general practice) a target to reach 26,000 has been reached (that target includes non-clinical staff). Click below to learn more about physician associates and clinical pharmacists, which are a welcome addition to our practice.

Can the government get this over the line?

Waiting lists are a major policy area and there have been a number of initiatives around increasingly supply whilst managing demand.

On the supply side, there has been additional funding, expanding the workforce and premises and working with the private sector. From a demand perspective, more emphasis has been placed on prevention and supporting those on waiting lists.

Both sides of the equation are enveloped by supporting leadership, innovation and technology. A great strategy. However, the dial isn’t going down fast enough. Perhaps the real answer lies with culture. Both patients and staff. It’s hard to measure and tough to implement.

Surgical procedures only make up 20% of those on waiting lists

Culture eats strategy for breakfast

Peter Drucker

Not everyone is waiting for an operation

If we say ‘NHS waiting list’, an image of an older lady waiting for a hip replacement probably pops into your mind, right?

Actually, surgical procedures only make up 20% of the waiting list. The other 80% is for outpatients, such as gynaecology or neurology.

Appointments not taking place

Each year why do 10 million patients simply not show up to their hospital appointments? Why do hospitals cancel 9 million appointments? More work needs to be done to understand the reasons behind this and what’s effective at reducing these figures.

If patients are easily able to amend or cancel their appointments through Patient Choice, then it’s likely to increase capacity.

Follow ups

Perhaps we could increase supply by freeing up follow-up appointments. There are 40 million follow- ups with consultants – but are there circumstances in which those could safely be released.

Could it be better for patients to have more flexibility in arranging their own follow ups? One initiative on is Patient Initiated follow-up PIFU.  

Is patient choice a glimmer of hope?

Potentially. It’s estimated that Patient Choice could reduce waiting lists by 3 months. The amount of work to reduce waiting times, especially when there is high current demand and a huge backlog, is almost overwhelming. Patient Choice may be part of the answer.

It has the potential to level off demand between hospitals, at the same time as empowering patients over when and where they’re seen. It gives patients an overview of their options. Additional supply will be added in the form of private providers.

A recap

Patient Choice allows patients to have the choice of 5 hospitals when they receive a referral from their GP.

They can see and compare waiting times, distance and quality for each of those hospitals. Then they can choose which option they prefer and book, amend or cancel their appointment themselves – all online, with the NHS app or over the phone.  

Patients

Research from Patients Association has shown that 73% of people are happy to travel 30 minutes to get faster treatment, so maybe it’s a question of not giving them enough choice. There could be issues around transport follow up care, having to travel for investigations.

At Hiyos, we’ll carry out our own analysis, but our initial thoughts are that it would work for patients who have their own transport and don’t have too far to travel. It could lend itself to someone who is due to have surgical procedure and can convalesce with relatives in an area with shorter waiting lists.

Hospitals

For the system to work, patients will need to be able to book in an appointment with the hospital. We expect the challenges will mirror those in general practice with changes in the admin processes and investigations. In the coming weeks we will investigate this.

General practice

There would potentially be more work associated with the referral, talking patients through the options available between different hospitals.

However, it could reduce admin work whilst patients wait, as they have more control over their appointments. Understanding referral guidelines for different areas and well as logistics of investigation and follow up treatment may also result in challenges.

We feel the key to success is aligning GP and hospital admin. You can see our initial thoughts in the videos below. Either 1 min or 12min. Why not watch both? 🙂

Work experience projects

We run regular NHS work experience programmes. Following the launch of Patient Choice, we asked our recent attendees to create content to raise awareness of this new initiative. Here is some of their fab work.

To conclude

It seems a pretty good idea to us, However, it’s by no means a magic wand. If we can align admin between hospitals and general practice and raise awareness with patients, it has the potential to reduce overall admin and give patients more choice and control.

Hiyos will be testing Patient Choice with patients and hospitals in the coming weeks. You can be sure that we’ll be sharing what everyone on the ground thinks about it! 

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