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16th October 2024
Patients who are waiting for planned trauma and orthopaedics and ear, nose and throat services are facing the longest waiting lists in the NHS system, according to a report by the Nuffield Trust and Health Foundation.
As of May 2024, these two specialisms made up almost one fifth of the total waiting list size (11.0% and 8.6% respectively) for planned hospital care. They are waiting an average of 15.4 and 17.6 weeks respectively.
The report said trauma and orthopaedics services are more likely to treat people requiring overnight admission and longer lengths of stay in hospital than other specialities, which limits their capacity to treat patients.
However, it added that the Covid-19 pandemic may have also negatively affected access to these services more than others, as there were ‘greater relative drops’ in the number of admitted patients compared to non-admitted patients.
Oral surgery has the longest median waiting times, with 17.7 weeks, however it is only the thirteenth largest waiting list overall.
The report also highlighted that respiratory medicine and gynaecology services had the largest increases in waiting list sizes over the past 10 years.
Respiratory services, which currently has one of the smaller waiting lists compared to other specialisms, had a 263% increase between May 2014 and May 2024. Gynaecology had the second largest increase, with 223% uplift over the same period.
The report said: ‘For respiratory medicine, this might be a consequence of increasing emergency care needs diverting resources away from planned care as a result of direct Covid-19 infections or exacerbations of respiratory diseases due to changes in the occurrence of respiratory viruses post pandemic, such as respiratory syncytial virus (RSV).
‘In addition, with the emergence of long Covid, the respiratory medicine workforce are caring for a whole new group of patients suffering long-term symptoms following a Covid-19 infection.’
Meanwhile one in 20 waits for gynaecology services were more than 52 weeks, which is the third largest number across the services.
‘The 2022 Elective Recovery Plan for the NHS focused on prioritisation based on clinical need and to reduce long waits over 65 weeks. This has been criticised as not effectively prioritising these services and may have resulted in waits for gynaecological services not improving as much as orthopaedic services which had more of the very longest waiters,’ the report said.
However, it added that waiting lists have increased across all specialities apart from general internal medicine and mental health services.
It comes after health secretary Wes Streeting said the Government plans to get hospitals running like a ‘Formula 1 pit stop’ to deliver up to four times more operations than normal.
The report also looked at waits for emergency services, with patients with psycho-social or behavioural problems waiting longer than other patients, with an average of 11 hours and 59 minutes for those who were admitted and seven hours 19 minutes if not admitted.
It also looked at the demographics of patients waiting longer in A&E and found that more people from deprived areas attend A&E but waiting times are similar across all levels of deprivation.
However, children from Black, Asian and mixed ethnicities were seen to wait longer than white children.
The report said: ‘When we look at the youngest age group (those aged 19 and under), patients of Black ethnicities waited longer – on average three hours and 41 minutes – compared to white children and young people, who waited approximately three hours and 20 minutes on average.
‘Further analysis by 10-year age bands revealed longer waits for Black patients up until the age of 40. Amongst patients who were admitted, Black people of all ages were found to wait longer than white people.’
A version of this article was originally published by our sister publication Healthcare Leader.
25th September 2024
The Government will target areas with the ‘highest numbers of people off work sick’ for a new initiative to get hospitals running like a ‘Formula 1 pit stop’, according to health secretary Wes Streeting.
Speaking at the Labour Party conference, Mr Streeting announced plans for ‘crack teams of top clinicians’ to go into hospitals and roll out reforms in operating theatres.
The new ways of working have been developed by surgeons and can deliver ‘up to four times more operations than normal’, according to Labour.
This model is based on operating theatres at Guys and St Thomas’ in London, which Labour said ‘run like a Formula 1 pit stop to cut time between procedures’.
Mr Streeting said the initial focus on 20 hospital trusts in areas with the ‘biggest rates of economic inactivity’ is based on the Government’s commitment to ‘moving the dial’ on its ‘growth mission’.
In January, a census report found that over half of the UK surgical workforce faced problems accessing theatres, which was contributing to long waiting times for hospital treatment and excessive workloads.
And the following month, the Times Health Commission called for high-intensity theatre lists to be launched once a month in 50 hospitals to get through a week’s worth of planned operations in a day and create seven-day surgical hubs.
During his Labour Party conference speech, the health secretary also promised to maintain the NHS as a service which is free at the point of use, claiming that the ‘crisis’ left by the Conservatives means that ‘seven in 10 people now expect charges for NHS care to be introduced’.
‘I’ve said it before, I’ll say it again: over my dead body. We will always defend our NHS as a public service free at the point of use, so that whenever you fall ill, you never have to worry about the bill,’ Mr Streeting told the conference.
As well as the focus on areas of high ‘economic activity’, the health secretary also indicated that Government initiatives will be targeted at ‘disadvantaged areas’.
He argued that patient ‘choice’ should not ‘just be the preserve of the wealthy’, and that ‘power should be ‘in the hands of the many’.
‘So, starting in the most disadvantaged areas, we will ensure patients’ right to choose where they are treated, and we will build up local health services so it’s a genuine choice,’ Mr Streeting added.
Earlier this month, ahead of the publication of the Darzi review, the health secretary set out three ‘strategic shifts’ for the NHS’ which included moving care from ‘hospital to community’.
A version of this article was originally published by our sister publication Pulse.
30th October 2023
Waiting lists for elective NHS care will reach a high of eight million people next summer if current trends continue, regardless of strike action, according to new analysis.
A Health Foundation report has projected the future elective backlog based on four different scenarios – none of which achieve the expectations of the Government’s elective care recovery plan.
If current activity growth continues at 7.4% a year and there are no more strikes, the list will peak at around eight million in August 2024 before dropping to 7.8 million by the end of the year, the think tank has found.
However, in another predicted scenario, if activity growth remains the same and strike action continues, the resulting waiting list will be around 180,000 higher.
The Health Foundation also found that strike action already taken by consultants and junior doctors has increased the waiting list by roughly 210,000, which equates to 3% of the overall list size.
Latest NHS figures show that as of August, 7.75 million people were waiting to start their first treatment, which is a record high.
At the start of last year, NHS England published the elective care recovery plan which reiterated the goal to deliver around 30% more elective activity by 2024/25 than before the pandemic, and set out an expectation to see the waiting list reducing by March 2024.
And in January this year, Prime Minister Rishi Sunak pledged that NHS waiting lists would fall, making it one of his five key priorities for 2023.
However, even in the Health Foundation’s ‘better-case scenario’, with hospital activity growth increasing by a third, the waiting list will only fall to below 7.2 million by the end of next year, which is the same level as when the PM made this pledge.
The report has also found that the monthly number of GP referrals to treatment, having returned to pre-pandemic levels, is in fact increasing at a faster rate than before.
According to the authors, this is down to patients who had put off seeking treatment during the pandemic now coming forward.
Although NHS secondary care is also increasing the number of treatments delivered each month, it cannot keep pace with the number of referrals.
Director of data analytics at the Health Foundation Charles Tallack said industrial action has only ‘directly resulted in a small increase’ to the waiting list, despite Government rhetoric.
Mr Tallack said: ‘Ministers have been quick to blame industrial action for the lack of progress in reducing the waiting list but the roots of this crisis lie in a decade of underinvestment in the NHS, a failure to address chronic staff shortages and the longstanding neglect of social care.
‘The pandemic heaped further significant pressure on an already stressed system but waiting lists were already growing long before Covid.’
He also said that returning waiting times to 18 weeks will be ‘very challenging’ but ‘entirely possible’ if the Government focuses on policy action and investment.
BMA chair of council Professor Philip Banfield said the new analysis shows that doctors ‘are not the ones to blame for the shameful backlog in NHS elective care’.
He said: ‘While there is no doubt that industrial action has had an effect on the ability to reduce waiting lists – something that could have been avoided entirely if the Government had come to the table willing to listen to doctors in the first place – it pales in comparison with a decade of failure of policy on the NHS from the top.
‘The Government needs to rethink its priorities: now is not the time to abandon patients in ideological stand-offs with the doctors who can materially improve the situation.’
Shadow health secretary Wes Streeting said the report ‘blows out of the water the Conservatives’ attempts to blame doctors and nurses’ for the NHS crisis.
‘Rishi Sunak’s failure to stop the strikes has only made a terrible situation worse, leaving even more patients waiting in pain and discomfort, unable to live their lives to the full,’ Mr Streeting added.
In August, the Prime Minister claimed that long NHS waiting lists were down to striking doctors, saying the industrial action is the reason patients have to wait for appointments.
And earlier this month, NHS England formally warned the BMA, saying strikes are now causing ‘significant disruption and risk to patients’.
The Government has recently agreed to meet with the BMA Consultants Committee in the hope of finding a resolution to the current dispute, which will be the first formal talks between the two parties since May.
A version of this story was originally published by our sister publication Pulse.
11th August 2023
Patients who need treatment will be quickly allocated to a hospital with sufficient capacity via a newly launched ‘matching’ platform in order to help bring down elective backlogs, NHS England has announced.
The tool will allow NHS staff to view and add available surgery slots in hospitals across the country, including in the independent sector.
According to NHS England, clinical teams will be required to upload details of patients willing to travel who are on their waiting list, with other NHS providers able to match people up to treatment. Options are then passed to the patient to choose from.
The tool was originally introduced for patients needing a hospital admission but has now been expanded to include cancer, diagnostic checks, and outpatient appointments.
NHS England said the system is mainly to be used for patients who have been waiting the longest, and views it as a key tool in eliminating all 65-week waits by April 2024.
Gynaecology, colorectal, trauma and orthopaedics have benefitted most from the mutual aid so far, NHS England said.
NHS chief executive, Amanda Pritchard, commented: ‘Despite significant pressure on services, NHS staff have already made incredible progress against our elective recovery plan, and this smart new tool will help us to continue to reduce long waits for patients.
‘It shows, once again, the benefits of having a national health service – NHS staff can now work even more closely with other hospitals across the country to identify capacity and conveniently match patients to available treatment and appointment slots.’
This comes as NHS England announced a record 7.57 million people are now waiting for NHS hospital treatment – three million higher than it was before the pandemic.
More than 383,000 people had been waiting more than 52 weeks to start routine treatment by the end of June, which had dropped slightly from 385,000 a month earlier.
And around 7,170 people were waiting more than 18 months at the end of June, compared to 11,400 in May. This is despite NHS England’s pledge to eliminate all 18-month waits by April 2024.
What’s more, NHS emergency departments experienced their second busiest ever July, with 2.1 million attendances. The summer is on track to be the busiest on record.
The NHS also experienced another record month for cancer checks with over 261,000 urgent referrals in June, and a near-record number of people starting treatment for cancer at 29,479.
Commenting on the overall NHS figures, deputy chief executive at NHS Providers Saffron Cordery said: ‘A perfect storm of squeezed funding in the NHS, the pandemic, the cost-of-living crisis, workforce shortages and now industrial action has pushed the waiting list to its highest point at 7.57 million.
‘This will ring alarm bells for trust leaders up and down the country as mounting care backlogs inevitably pile more pressure onto an already overstretched NHS. Amid ongoing strikes, this is an extremely busy summer for A&E while ambulance services also face very high demand and more urgent calls.’
Assistant director of policy at the Health Foundation Tim Gardner added: ‘Industrial action has hampered efforts to address the backlog, but a lack of staff and capacity meant the waiting list was increasing long before the pandemic and had reached 7.2 million before the first strike towards the end of last year.’
He continued: ‘While ministers have been quick to blame strikes for the lack of progress, the roots of this lie in political failures to tackle rising pressures over the last decade. There are no quick fixes – ensuring people get the care they need at the time they need it hinges on the Government acting to address the underlying problems facing the health service, which includes historic under-investment in equipment and buildings, as well as delivering the long-term workforce plan to address the significant staff shortages.’
22nd May 2023
Increased use of the independent sector to drive down waiting times is having a ‘limited impact’ on NHS backlogs, a major think tank has said.
A report published by the Health Foundation concluded that greater use of the independent sector providers (ISPs) is ‘no substitute’ for addressing wider issues such as staff shortages, social care and underfunding.
Analysis by the foundation examined the use of ISPs in the delivery of NHS-funded ophthalmic and orthopaedic care – two areas where the independent sector’s share of care has grown most.
But it found in ophthalmology, the NHS was treating patients more quickly than the independent sector in November last year.
By comparison, in 2018, there was almost no difference with approximately 75% of patients waiting for ophthalmic treatments in England being treated within three months by the NHS or an ISP.
Charles Tallack, director of data analytics at the Health Foundation, said: ‘While it has an important role to play, the independent sector is not a panacea for bringing down waiting lists, despite it being at the heart of the elective recovery plan.’
The waiting list for planned hospital care – which stood at 7.21 million in January – has grown by 58% since just before the start of the pandemic. Children waiting for consultant-led care is now at all-time high.
To help expand capacity and address this backlog the NHS has been looking to ISPs to treat more NHS patients.
NHS performance bounced back in 2021 and 2022, but the independent sector has seen that figure drop to below 60% in 2022.
For orthopaedic care, waiting times have increased across both the NHS and ISPs since 2018, though this has been more pronounced for ISPs, resulting in patients facing similar waits regardless of whether they are being treated by the NHS or an ISP.
The report suggests that while ISPs might be supporting activity levels, much like NHS providers, they are struggling to deliver care quickly and are unlikely to help bring down overall waiting lists.
Mr Tallack added: ‘To truly increase activity and bring down waiting lists, the government must address the major problems facing the NHS – from the lack of an adequate workforce plan to historic under-investment, as well as pressures in social care.’
The study also raised questions about inequalities in access to independent-sector-delivered NHS care. In ophthalmology, the analysis found that post-pandemic, overall treatment volumes in the most deprived areas were still 1% lower than before the pandemic, while in the richest areas they were 5% higher.
And in both specialities, white patients were consistently more likely to receive NHS-funded care delivered by the independent sector than patients from other ethnic groups.
A version of this story was originally published by our sister publication Pulse.
15th May 2023
The number of children waiting for NHS hospital appointments has reached an all time high, the latest NHS figures show.
There are currently 403,955 children waiting for consultant-led care, of which 18,000 have been waiting for more than a year for essential treatment, the UK’s Royal College of Paediatrics and Child Health has warned.
The College notes that while there has been considerable progress made in shrinking the adult backlog, the children’s list ‘continues to rise at an unprecedented rate’, with ‘children not being prioritised’.
Long waits for children are of particular concern, given many treatments and interventions must be administered within specific age or developmental stages, a statement from the College said. And the data does not capture the full scale of the problem, it added, with hidden and growing waiting times for community care.
The RCPCH has called on the Government to set aside ringfenced funding for children’s service recovery at all community, elective, and urgent care levels, as well as publishing a fully-costed NHS workforce plan immediately.
The figures come as NHS England said the number of patients waiting more than 18 months fell to just 10,737 by April – down by more than 90% from 124,911 in September 2021 and by more than four-fifths since the start of January when there were 54,882.
RCPCH president Dr Camilla Kingdon said: ‘It is a national scandal that over 400,000 children are stuck in limbo on a list, waiting for treatment.
‘These children could fill Wembley stadium four times over. NHS England has a zero-tolerance policy for 52-week waits, so it is deeply concerning that these targets are being missed.
‘The clear regional variation in size of waiting lists also means that this is an equity issue for children and their families. Child health teams are working tirelessly to address the growing backlogs, but without proper support, their efforts are unable to make a meaningful dent in the problem.’
RCPCH officer for health services, Dr Ronny Cheung added: ‘It’s clear now that the voices of children are not being heard. It seems that the focus in the lead up to the next election is primarily on voting-aged adult issues.
‘Lengthy waits are unacceptable for any patient but for children and young people the waits can be catastrophic, as many treatments need to be given by a specific age or developmental stage.
‘In recent months we’ve heard about children missing school, quitting sports, and missing out on the important aspects of a healthy, happy childhood. This is not a trivial matter.’
Meanwhile, statistics published by NHS England showed that the overall elective waiting list has grown to a record high, with 7.3 million people now waiting for treatment.
A version of this story was originally published by our sister publication Pulse.
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