NHS waiting times are a ticking time bomb we should address before winter

Patients and staff deserve better, digitisation and knowledge-sharing is the way forward

Owain Rhys Hughes
Friday 18 September 2020 10:53 BST
Matt Hancock quizzed on people driving hundreds of miles for a Covid test

The consequences of Covid-19 can be felt almost everywhere. But nowhere is its legacy proving more destructive than within the very system sought to contain it. After a tumultuous few months battling the worst health crisis in a generation, the NHS is already facing another immediate threat – the longest patient waiting lists since records began.

Some 2.5 million people were waiting more than 18 weeks for operations in July, compared to over 620,000 this time last year. NHS waiting times have long been cause for concern, but Covid-19 delays and backlogs have seen them spiral out of control. 

I’ve experienced first hand the knock-on effect of the waiting times crisis, placing increased pressure on already stretched clinicians and breaking trust with the patients in their care. NHS staff are doing their best, but they need more help.

With winter pressures looming – and all signs pointing to an imminent second wave of Covid-19 – delaying treatments and operations is no longer a viable solution. Instead, we must abandon the playbook followed over the last few months, forging sustainable solutions that can withstand a second wave and see Trusts claim back control.

No one is saying that this will be easy, but it definitely isn’t impossible. Yes, Covid-19 control measures are slowing the pace of procedures; but this doesn’t mean Trusts can’t continue to think outside the box, to up capacity and deliver care elsewhere or in new ways. Hospitals can’t stop cleaning regimes, social distancing or PPE, but Trusts can be doing more to leverage community networks, technology solutions and partnerships with private health providers. Not doing so risks creating a parallel crisis with devastating long term implications.

Embracing the new wave of digital technologies is going to be key, and health tech front runners are already offering targeted solutions to service-wide problems. Not every digital tool is right or ready to be integrated, but the removal of many barriers to entry has enabled a clutch of new players to make their mark.

We’ve seen widespread adoption of key technologies like telehealth and digital pharmacies this year; and forward strides like cancer triage platform Kheiron Medical’s recent NHSX win are moving us, inch by inch, in the right direction. But Trusts must apply the same open mind to new areas and specialisms; and fast. Digitisation needs to become a central investment priority.

It also figures that smarter triaging is going to be one of the strongest solutions. Too many patients are being sent to see specialists in hospitals, when local community care networks can help. To support GPs in referring patients more appropriately – and to keep patients out of the hospital where possible - tech-powered triage platforms like Cinapsis for referrals should be used to connect primary and secondary care. Specialists can share their advice and guidance in real-time, and support primary care to make the best referral decisions.

Caring for patients in communities – rather than in hospitals or A&E – will instantly stem the flow to waiting lists, improving outcomes, and easing burdens on staff. In One Gloucestershire ICS – where digital triage tech is in use across each of its Trusts – the number of unnecessary A&E referrals has reduced by a staggering 83 per cent. Here are collaborative solutions that work. Trusts must move faster to integrate them.

It also boils down to getting patients the care they need the first time around. Thursday’s announcement – that patients will have to call 111 before visiting A&E –  highlights how funnelling patients through narrow channels (to specialists they might not even need to see) is misspending the time of clinicians who don’t have any time to waste.

A strong short-term solution, while we strengthen the NHS’ lines of defence is to leverage private care networks; as we did during Covid-19 admission peak. Health Secretary Matt Hancock has already hinted that this will prove “critical”, but clarity as to when or how is still lacking despite immediate need. Private hospitals stepped up before, so Trusts must use this as a roadmap now. With an estimated 515 private hospitals offering healthcare services in the UK alone, leaning on private sector support could increase capacity by up to 40 per cent.

If we’re to undo some of the damage done and cut down NHS waiting times, connection and collaboration must become a prerequisite. Capacity is going to continue to be squeezed, whether we face a second wave or tackle localised lockdowns. But we do know more than we did in March – when there was no blueprint, no research nor the blessing of hindsight. We’re living and breathing Covid’s consequences, but must learn from the lessons of the last few months if we’re to change the narrative and protect staff and patients.

Trusts must look to solutions that save clinical time for those in most need. Broken and bureaucratic processes must be overhauled and remodelled, and tech-powered collaboration, communication and knowledge-sharing has to become the order of the day. If Trusts don’t act now we’ll face the perfect storm, with winter pressures, a second wave, and millions-long waiting lists – resulting in a catastrophic winter crisis. Patients and staff deserve far better, or risk finding out that the worst is yet to come.

Dr Owain Rhys Hughes is a former NHS ear, nose and throat surgeon for the NHS, and has since founded Cinapsis to help GPs and NHS Trusts reduce unnecessary hospital visits

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