Who is on a waiting list?

Amanda Pritchard (NHS CEO) is reported at saying  at the NHS ConfedExpo conference in Manchester  on June 14th that: “More than four-fifths of people on the waiting list require an outpatient appointment such as a follow-up for cardiology or rheumatology – rather than a surgical procedure.”

Source: James Illman  Pritchard: We need to be ‘really thoughtful’ about intervening with ICSs   Health Service Journal   14 June 2023

Are waiting lists organic?

Growing waiting lists for care pre-date the pandemic, following a decade of funding settlements that failed to keep up with rising demand for services and growing staff shortages. 

Covid-19 also substantially contributed to growing waits for care, with many services operating at reduced capacity during the pandemic and pent up demand being created as large numbers of people did not come forward for care.

The principal rate-limiting factor on the ability of the system to increase activity and treat more patients is the availability of staff. Any plan to reduce waiting times needs to build explicitly from an analysis of the workforce needed to deliver it. The operational planning guidance also sets out the expectation for systems to increase activity levels to 130 per cent of pre-pandemic levels by 2024/25. 

The government estimates that waiting lists will continue to grow until 2024. It will be several years before waiting lists and waiting times return to pre-pandemic levels

Source: NHS waiting times:our position  King’s Fund  Last updated  June 2022

Seven million missing patients

NHS waiting lists have grown by less than a million since the start of the pandemic despite there being 3 million fewer planned admissions and 17 million fewer outpatient appointments in the first ten months of the pandemic alone. This is because 7 million fewer people joined the waiting list between March 2020 and May 2021 than would otherwise have been expected.  What happens to waiting lists in the short term will therefore depend crucially on what fraction of these 7 million “missing” patients come back for treatment. 

In the longer term, NHS capacity to deal with non Covid patients will be crucial. Even if only two thirds of the missing patients return then with capacity at 95% of pre-pandemic levels – much more than the NHS is currently managing – waiting lists could easily exceed 13 million (and keep growing). Expanding capacity will be the only solution to cutting waiting lists in the future.

Source: Stoye G, Warner M & Zaranko B   Sajid Javid’s warning of a 13 million NHS waiting list is well within the realms of possibility Institute of Fiscal Studies 8 August 2021   

Eligibility for NHS Continuing Healthcare assessments 

To be eligible for NHS continuing healthcare (CHC), you must be assessed by a multidisciplinary team. The MDT will relate your care needs to what help you need, how complex your needs are, how intense your needs can be, and how unpredictable they are, including any risks to your health if the right care is not provided at the right time. The Continuing Healthcare system is complex, dogged by lack of a clarity and understanding, and wildly inconsistent across regions.

While the number of CHC assessments is returning to pre-pandemic levels, the proportion approved continues to fall with only one in five (21%) approved for CHC funding between January-March 2023, bringing the eligibility rate for the last financial year to a mere 22%. This continues a gradual downtrend in the eligibility rate which has ranged around 24%-26% between 2018-19 and 2020-21, before dropping to 23% in 2021/22 and falling again in the last financial year.

Source: https://www.beaconchc.co.uk/what-is-nhs-continuing-healthcare 

Lost in translation?

NfN moles are often asked to explain words used by NHS staff, so News from Nowhere is collecting examples of translation from health speak to plain English. Here’s one about closing an A&E department, first in health speak then in scepticism.

 'We firmly believe the proposals offer better, more sustainable hospital services for the region. Decisions about the future shape of services will be made after the responses to the public consultation have been considered in full.'
 

Translation  'We are fully aware that this will lead to a significant deterioration in service for local people, because it is absolutely blindingly obviously a bad idea - but we aren't going to admit to that as it would spell the end of our careers. We will do the usual air-cover nonsense of pretending to ask local people for their opinion before doing what we planned all along anyway.' Send us your favourite translations, do.

Source: Anonymous Health Service Journal :13 July 2023 

PEP, PINA & PIFU

Giving patients digital control over their hospital appointments could avoid 1.6 million unnecessary appointments and create a national annual system saving of £167 million, according to a new report commissioned by DrDoctor, the UK’s leading patient engagement platform (PEP) supplier. 

The report – conducted by Edge Health, a health economics consultancy – analysed outpatient appointments in the NHS, revealing that  using Patient Initiated New Appointments (PINA) and Patient Initiated Follow-Ups (PIFU) - which allows patients to request appointments - can significantly cut the NHS elective backlog.   

Data from Guy’s and St Thomas’ NHS Foundation Trust’s physiotherapy services were used for the evaluation. The time and cost savings from more than 50 million outpatient appointments were extrapolated to calculate the overall impact on the NHS. 

The study reveals that putting patients on digitised PIFU pathways for both high-volume low complexity conditions and smaller volume higher-complexity conditions could lead to at least 1.2 fewer outpatient follow-up appointments per patient. If implemented nationally, this could free up the waiting list for 1.4 million hospital appointments, create capacity for more patients to be seen, and save the NHS £167 million per year.  

Source: https://www.drdoctor.co.uk/

Causes not symptoms?

Researchers at the Universities of Northumbria, York, Bath and Strathclyde, in collaboration with think-tanks ‘Compass’ and ‘Autonomy’, have presented ground-breaking evidence on the role that Basic Income can play in dealing with our public health crisis. 

‘Treating causes not symptoms: Basic Income as a public health measure’ uses a range of economic and health modelling, public opinion surveys and community consultation to present cutting-edge evidence on the impact of Basic Income schemes. 

Public health impact: 

• Between 125,000 and 1 million cases of depressive disorders could be prevented or postponed.

• Between 120,000 and 1.04 million cases of clinically significant physical health symptoms could be prevented or postponed.

• Between 130,000 and 655,000 quality-adjusted life years (QALYs) could be gained, valued at between £3.9 billion and £19.7 billion.

• Based on depressive disorders alone, NHS and personal social services cost savings in 2023 of between £125 million and £1.03 billion assuming 50% of cases diagnosed and treated.

Economic impact: 

• Even a more ‘modest’ basic income scheme (£75 a week, £3,900 a year) would reduce child poverty to the lowest level since comparable records began in 1961 and achieve more at significantly less cost than the anti-poverty interventions of the New Labour governments. 

• Child and pensioner poverty down by at least 60% each

• Working age poverty down by between 29% and 75% depending on the scheme

• Inequality down 55% to the lowest in the world under the most ambitious scheme

The report also found the British public prefers a more generous Basic Income scheme that significantly reduces poverty and inequality and improves physical and mental health. 

Source: https://www.compassonline.org.uk/publications/treating-causes-not-symptoms-basic-income-as-a-public-health-measure/

 Another big breakthrough (not) 

Is the new drug Donanemab really a step-change in the treatment of early Alzheimer’s disease, as Big Pharma claims? A recent drug trial showed that Donanemab delayed decline in thinking and memory, but those taking it did not improve. In other words it is not a disease-modifying cure. 

Adverse effects, including swelling of the brain, were common at 24% and three people died from taking the drug. We do not know if this new medication will have effects on the ubiquitous behavioural, psychological and social disturbances that can make care of the person with dementia so difficult, because the trial was not focussed on them, despite their needs. Participants in the trial were overwhelmingly white, making extrapolation of trial results to other ethnic populations unreliable. 

Those offered Donanemab will need to weigh the potential benefit of treatment (delay of progression of about 4 months on average) with the financial and quality-of-life costs of monthly intravenous injections, regular MRI monitoring, and risk of shrinkage of the brain.

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2100708