Can the NHS clear its backlog?


There are currently over seven million people in England, Wales, Scotland and Northern Ireland waiting to be treated by the NHS. Elective procedures and examinations, as well as treatments for cancer, heart disease, and other conditions, continue to pile up.

The health service is packed in every country. FROM 700,000 electives be made in Wales, Welsh conservative Russell George said that Labor should “stop breaking all wrong records”; Humza Yusuf, SNP health minister, was said to other MSPs to “finally show leadership and take control” of the 550,000-strong Scottish waiting list; while Northern Ireland Health Minister Robin Swann It has noted that his current figure 120 097 people waiting for treatment is “simply unacceptable”.

Plans have been made to close the backlog, but some experts believe things could get worse before they get better.

“A lot of this depends on what is called “missing referrals” or “missing patients,” says Steven Rocks, an economist at the charity Health Foundation. Searchlight. Such patients are those who would otherwise go to their GP or go to the hospital for their illness were it not for the pandemic causing fear of the as yet untreated masses of people. (National Control and Auditing Service estimates between March 2020 and September 2021, there were 7.6 million to 9.1 million fewer scheduled care requests.) your recovery plan.”

NHS England recovery plan, published in February, acknowledges that the elective treatment waiting list, which currently stands at 6.4 million in England, “is likely to increase, at least in the short term”. Similar recovery plans in Wales, Scotland and Northern Ireland also acknowledge this reality.

While funding commitments and staffing levels vary, home country plans to close the backlog share the same general premise: treat the sickest first, treat those who waited the longest quickly, and restore the speed of healthcare to pre-pandemic levels. levels.

It will take years to clear the backlog. In England, which is the furthest behind, number of people those who waited more than a year for treatment are 186 times higher than before the pandemic. Currently, the average patient spends 13.1 weeks waiting for treatment for various conditions.

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As part of the NHS recovery plan, England has committed to spend £8bn over the next three years, including a £5.9bn capital investment in beds, equipment and technology. It is hoped that the separation of elective care from acute and acute care, through the expansion of newly established local community diagnostic centers, new specialized surgical centers, and the offer of treatment through independent providers – free of charge at the point of use – will lead to a decrease in the number.

There are also plans to add additional staff to the service, although it remains unclear whether long-term needs will be met. NHS England plans to hire 60,000 more nurses by 2025, which is the same number The Health Foundation predicts it will need to move forward; however, there have been no formal plans to hire the 247,900 employees, including 23,900 doctors, 6,600 general practitioners and other support staff that the think tank predicts the health service will need to keep up with demand over the next decade.

And while the NHS employs a record number of people, it also has a record number of vacancies: more than 100,000. “We don’t think the current plans go far enough without the NHS providing enough staff to meet the needs of the population,” Rox says.

The health service has a recent history of underfunding and understaffing. “Waiting lists were growing even before the pandemic,” notes Rocks. “The National Health Service faced these challenges, especially in the 2010s,” he said, referring to the years when the conservative government pursued austerity policies. “We’ve seen below-historic levels of funding growth – and as such, we’ve started to see the waiting lists tick.”

The pandemic is often blamed for falling behind, but before it, more than 4.43 million people in England were on the NHS waiting list – a record at the time.

Staff shortages and shortages of beds, facilities and equipment are key fundamental issues that cannot keep up with rising demand, said Siva Anandachiva, chief analyst at think tank King’s Fund. “The whole system is interconnected; there’s no point in having a flat surface that you call a hospital bed if you can’t staff it, and you can’t staff it if you don’t have the budget.”

Anandachiva, who previously helped develop policy at the Ministry of Health, believes that since the financial crash of 2008, the NHS has fallen into a “vicious cycle” in which various “hard-won gains” such as making four-hour emergency calls and urgent care expectations and the 18-week standard of referral to achieve treatment goals have worsened.

“For people like me, 3,000 to 4,000 people waiting to leave for over a year was considered anathema; it was seen as a massive system failure,” he adds. “Now you get a 100x magnification [of waiting lists] in some cases. You’re constantly reviewing how bad it looks.”

To try and keep up with general demand, the NHS has strengthened its relationships with independent health care providers over the past two decades. Additional beds and staff have been hired by the private sector during the pandemic. AT recent public accounts committee hearingAmanda Pritchard, Chief Executive of NHS England, said continued relationships with private providers “will play an extremely important role” in closing the backlog.

Is the NHS getting too trustworthy with independent providers? “I don’t see any conceivable way to catch up without a heavy role for the private sector,” says Anandachiva. Not only is the private sector providing additional beds and general facilities through subcontracting, he adds, but by providing care for those who have the means to pay, it gives the NHS fewer people to treat, allowing it to breathe.

But many qualified NHS staff also take on some of the work for independent providers. Such duplication, Anandachiva warns, means the service could face increased staffing pressure. “This is an exchange of anesthesiologists, surgeons, senior consultants, nurses and allied health professionals,” he says.

Real wage cuts, limited career progression, dissatisfaction with pensions and the pressure of working in an overburdened system record numbers employees leave the NHS: around 140,000 left between September 2020 and September 2021. “People are incredibly tired – they’ve been working beyond their normal hours for two and a half years,” says Gary Hosam, a general practitioner in Peterborough and Vice President of King’s College. general practitioners.

The lag also has a negative impact on other areas of health: according to the NHS, at the primary health care level, general practitioners have to deal with more patients than ever before; emergency rooms are easily overwhelmed by the consequences of untreated patients; and a lack of social care capacity makes it difficult to discharge elderly patients receiving routine care. “You have to be very careful that when you focus on one part of the system [that] you don’t get unintended consequences elsewhere,” Howsam says.

While many agree that the promises made in the long-term plans will help in one form or another, the failure to come up with a strategy or funding to significantly increase staff levels and capacity means that a lag is likely to remain. “Even with a tailwind, we would be incredibly lucky if the waiting time returned to the state it was before the pandemic, not to mention return to the state it should be,” says Anandachiva.

Trusts in the NHS and patients themselves can expect to change, he adds: hospitals in the same region will soon be able to “pool” resources to work together to address patients and specific problems, rather than acting as separate organizations, while patients can more easily access care. with more local treatment regimens.

“But, unfortunately, for at least the next few years, I think most of the conversation will be better at explaining to people why they are waiting so long for the help they need,” says Anandachiva.


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