Government plans to reduce the hospital backlog in England are facing criticism from health leaders, who argue that reforming how services are delivered is crucial for success. Labour’s strategy to increase the number of weekly appointments and operations by 40,000 is designed to address the 18-week waiting time target, but research from the NHS Confederation suggests this will only contribute about 15% of the additional capacity required to meet that target. This target has not been consistently achieved since 2006. The Confederation advocates for a broader overhaul of hospital care, including the adoption of digital technologies to enhance efficiency. This critique is being voiced just ahead of the government’s release of a review on NHS performance later in the week.
The review, led by NHS surgeon Lord Ara Darzi, was commissioned by Health Secretary Wes Streeting following the general election. Its purpose is to highlight the key obstacles in reducing waiting times. According to sources familiar with the review, it is expected to be a candid report, including criticisms of productivity in certain areas. Additionally, the report is likely to spotlight concerns about the state of children’s health, which has seen significant decline over the past decade. Data suggests that more than 100,000 infants endured over six-hour waits in A&E departments across England last year, and around 800,000 children and young people are currently on NHS waiting lists for hospital treatments. Dr Mike McKean, Vice President of Policy at the Royal College of Paediatrics and Child Health, expressed concern, noting that many diseases affecting adults, such as cancer and cardiovascular issues, often originate from childhood health problems. Addressing health in childhood, he suggested, could create healthier adults who experience fewer health issues in later life.
In an interview with the BBC, Sir Keir Starmer referenced Lord Darzi’s impending review, describing the NHS as “broken” under previous Conservative governments. The review is anticipated to promote the expansion of surgical hubs that specialise in low-complexity, high-volume treatments like cataract surgeries and hip replacements. The Health Foundation recently reported that introducing these hubs has already led to a 20% increase in treatments in areas where they operate. Additionally, existing hospitals will be required to increase their capacity, with staff offered extra pay for weekend shifts in order to fulfil Labour’s pledge of providing 40,000 more appointments and treatments weekly.
However, the NHS Confederation’s research, in collaboration with consultancy firm Carnall Farrar, asserts that increasing activity alone is insufficient to address the 18-week target backlog. Currently, 7.6 million people are waiting for NHS treatment, with more than 40% of them having waited longer than 18 weeks. The goal is for 92% of patients to be seen within this timeframe. Matthew Taylor, chief executive of the NHS Confederation, emphasised the magnitude of the challenge, stating that simply adding more appointments and operations would not be enough. He stressed the need for structural reforms within the NHS.
The Confederation’s report calls for changes such as increased investment in digital technology and the use of robotic surgery and artificial intelligence. By implementing these technologies, significant savings could be made, particularly by reducing the number of pre- and post-treatment appointments. Follow-up care could be managed remotely, and, in some cases, patients could be given the option to seek further medical assistance only if they feel it necessary. Improving the integration of care could also decrease the number of appointments required for the 1.2 million people waiting for more than one treatment. The report also emphasises the importance of streamlining waiting lists, suggesting that time is currently being wasted on following up with patients who no longer require treatment, either because they have gone private, opted out, or, in some cases, passed away. While these changes could improve productivity, the report underlines that achieving this will require significant upfront investment in technology and facilities.
Preventative health measures are also recommended to reduce the number of patients needing treatment in the first place. In response, the Department of Health and Social Care acknowledged that productivity improvements and technological investments will be part of their plan. A spokesperson confirmed that although fixing the NHS will be a complex, long-term process, the government is committed to delivering the necessary investments and reforms.
Meanwhile, Victoria Atkins, the Conservative shadow health secretary, accused Labour of using Lord Darzi’s review as an excuse to increase taxes in the upcoming Budget. She criticised Labour for a lack of transparency on this issue, stating that the NHS requires an honest conversation about the challenges it faces, but she does not believe Labour’s approach is the solution.
The backlog, currently standing at 7.6 million people, includes those waiting for multiple treatments, a point updated in recent government figures.
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