29 Sep 2021
The government recently announced that it is using part of the National Insurance tax levy to spend £2bn on tackling the elective care backlog. The question for many in the NHS is where to start to make sure this extra funding really has an impact.
Since the World Health Organization declared the COVID-19 outbreak a pandemic in March 2020, we have known that the impact on elective services was going to be considerable. This is because pressure in the system had already started to build as wards filled with COVID-19 infected patients and routine operations were postponed. However, during the first wave when virtually all elective procedures were cancelled, we started to get an indication of the scale of this problem.
As we know, it’s not just about rebooking cancelled appointments. Many patients were put off seeking help from their GPs. As a result, they have lived with conditions that have worsened and are likely to require more resource when an intervention is sought. Take cancer waiting lists where around 20% of activity comes through an elective care pathway. If these patients have not sought treatment, cancers will be discovered at a later stage when they are likely to be harder to treat.
The first challenge is to determine the size of the backlog. That means taking the postponed activity (the waiting lists that we know are there) and adding the activity from those people who didn’t book GP appointments. There has already been a significant amount of work done on the first element by cleaning up waiting lists – removal of patients for reasons other than treatment. It should also be possible to look at the waiting lists and determine how much theatre time is needed to start reducing the waiting list backlog.
However, determining the size of the backlog from people who haven’t presented is far more difficult. This could potentially be just as large as the known waiting lists. A first step here is to look at how many patients you would have expected to see across the main procedure groups that haven’t attended based on previous years’ demand. This analysis can be further refined by looking at acuity – in other words how much sicker might these patients be because they haven’t attended.
The final step is to factor in the demand that is likely to arise over the next five years. This should include an analysis of demand based long COVID-19 as well as other long-term conditions which will vary from region to region.
Given we have a responsibility to spend the extra funding where it will have the most impact: we need to focus on where the money is spent. Although £2bn sounds like a lot of money, it could easily be swallowed up in the healthcare budget, particularly as healthcare workers are burned out and locums are a costly solution.
This might sound like a tough ask, but we do have insight that can help. For example, through the combined teams at Telstra Health UK, Insource and Gooroo we have been using live data to inform decisions about capacity rather than looking retrospectively at what has been happening.
We can develop models that reflect rapidly changing environments. We can experiment with how various factors affect the time to resolve the problems. For example, the accelerated adoption of remote care, care closer to home, the 111 service triaging, increased sickness and absence rates, availability of private care facilities and changing theatre capacity. In short, we can model how care will be delivered and truly understand whether we have the resources to get back on track.
What’s more, we can exploit the data available to monitor and manage the care of patients still in the system rather than retrospectively recording where things have not gone as well as we would have liked.
What we need to remember in all this is that NHS capacity is not suddenly going to increase over night. Weekend working and mobile theatre suites can only do so much, but healthcare staff need to be found or trained and this cannot happen in an instant. There will be no quick fix, but by using the insight we have we can make sure an extra funding is well spent.