1/25 Trusts were asked in NHS March Planning Guidance to start planning on how to recover care backlogs. Early work now starting to show the scale of the problem. One of my long tweet threads follows on the detail of what's emerging. See p13 of @thesundaytimes and @SkyNews too!
2/25 Important to remember this isn't just about elective surgery and cancer backlogs in acute hospitals, though this is where the media and political focus is. There are serious backlogs in mental health and community services too that are just as important for their patients.
3/25 Also important to note trusts did a really good job recovering services last Summer/Autumn, after the first phase of COVID, meeting targets they were set. They were also able to provide more non covid care in Dec-Feb than in the first phase despite much higher covid demand.
4/25 Trusts also tell us that they are going as fast as they can, at the moment, and are making good progress in recovering the most urgent cancer, surgery and other cases. Trust leaders very aware of how important these cases are and that days/weeks of delay are often vital.
5/25 In doing their mid to long term planning trusts hampered by the fact that they don't know the full size of the problem yet. There has been a well publicised drop in the number of referrals e.g. for particular classes of elective surgery (see here: health.org.uk/publications/l…)...
6/25 ...We just don't know how many of these referrals will "bounce back". And we know some predictions - e.g. a waiting list of 10 million by April 2021 (independent.co.uk/news/health/co…) - will be wrong by a very long way. We will have a better idea of this in a few months’ time.
7/25 But trusts are now getting a clearer picture of the size of the task ahead and it's very concerning. There is a very significant care backlog that is going to take a huge amount of time/resource to clear. It's difficult to be precise but here are a couple of indications...
8/25 ...At the most extreme, some trusts in the worst position are telling us their initial estimates are that, on current trajectories, it will take them between three to five years to get back to the waiting times they should be delivering. They know this is not acceptable...
9/25 ...It's also striking how many long serving Trust Chief Executives are saying that they are very worried that the NHS is heading back to the beginning of the 2000's. A time when the NHS had far too many people waiting for years, not months, on waiting lists....
10/25 ...Having spent a good part of their careers working incredibly hard to solve that problem, those CEOs are adamant that the NHS must do everything it can to avoid returning to that position. Not least because that's our duty to NHS patients and service users.
11/25 Trusts believe they can clear backlog within a reasonable period of time. But it's going to require a radical bold transformative approach. Treating this as "another waiting list initiative" – just rely on lots of overtime and private sector usage - will be insufficient.
12/25 This is going to require a team approach – the NHS transforming how it provides care and the Government providing the extra funding required to enable that transformation. We will need to work very hard together over the next seven months to produce a joint plan....
13/25 ...for the rest of the parliament. We assume this will be for a multi year spending review at the end of this year. Early ideas from trusts on what is needed in both parts of the plan - the transformation elements and funding required - follow in the rest of the thread.
14/25 Five required elements of plan most mentioned are: 1. We will need to increase capacity - both physical and workforce capacity. There is simply not enough current capacity to get through the backlog quickly enough. Overtime/private sector usage will help but...
15/25 ..We won't, for example, be able to address the backlog of children with severe mental health needs without increasing the number of CAMHS inpatient beds. 2. We need to identify and then take a radical approach to tackling current pinch points / rate determining factors....
16/25 ...For example we need to speed up access to diagnostics by investing in community diagnostic hubs (hsj.co.uk/commissioning/…). We have to address shortage of anaesthetists. Speed of backlog clearance will be significantly determined by how we address pinch points like these.
17/25 3. Trust leaders know they will need to make a major push on increasing productivity and efficiency and reducing unwarranted variation by working together more effectively. The moves to system working and provider collaboratives provide important opportunities here.
18/25 4. The experience of the last few winters and COVID-19 shows that as soon as winter and COVID-19 pressures rise, most trusts have to cut their elective surgery activity. This makes rapid and effective backlog recovery more difficult. We therefore need to look at how....
19/25 ...We reconfigure hospitals quickly to enable them to better cope with future waves of COVID and winter pressures without having to cut back on elective surgery. Trust leaders clear that they can rapidly develop plans here but these will need investment support.
20/25 5. Rapidly adopting new ways of treating patients specialty by specialty. For example much greater use of new technology in ophthalmology which now has some of the biggest waiting lists, using approaches pioneered by trusts like @Moorfields. Hard graft in each specialty!
21/25 On funding part of plan. Key part of solution in early 2000s was five successive years of 7%+ real terms NHS annual funding increases, more than double current plans. And ruthless focus on cutting waiting lists. We need to recognise current context is very different...
22/25 …The pressures on our public finances are different. And there's a much wider set of NHS priorities to fund. Including delivery of the NHS Long Term Plan and living with COVID-19 longer term (Test and Trace / vaccinations), not just care backlog recovery....
23/25 …But Government will have to provide sufficient funding to enable the transformation that's needed here. So this year's non recurrent £1.5bn to start tackling elective waiting list backlogs and increase mental health capacity can only be a first instalment.
24/25 SUMMARY. Early work by trusts as a result of NHS March planning guidance shows there is a huge care backlog to clear. For the worst affected trusts, current estimates suggest that this will take 3-5 years to tackle on current trajectories....
25/25 ...Trust leaders know they have to go faster than this. This will need a bold and transformational approach that will require significant Government investment. We need to work together over the next few months to create a joint plan to deliver for patients/service users.
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