“NHS waiting times remain a key election issue. The elective care waiting list stands at 7.6 million, and the challenge of reducing it is huge. NHS standards for elective care waiting times have not been met since February 2016, while standards for ambulance and A&E waiting times have not been met since 2020/21 and 2015 respectively. A number of targets for recovering elective care and urgent and emergency services have also been missed.

The situation facing the NHS is arguably worse than at any other time in its history. There are no quick fixes, but the health service can recover with a long-term plan that combines the right mix of policy change, radical innovation and improvement, and long-term investment. 

The next government will need to take urgent action to make better use of existing hospital capacity and invest in expanding capacity for the longer term. Making sure people get the care they need will also require wider investment and reform of health and care services, and cross-government action to improve the nation's health”.

Source: Francesca Cavallaro et al How can the next government improve hospital waits in England? The Health Foundation 25 June 2024  

By any other name…

The row over “associate” practitioners in the NHS is getting nastier and nastier. The President of the Royal College of Physicians has finally resigned under pressure from her members. The BMA is launching legal action against the General Medical Council because of the GMC’s regulatory role in the accreditation of “associates”. The Royal College of GPs has advised its members to stop recruiting “associates” And rumour has it that the individuals used for these promotional posters produced by Bradford District and Craven health and care partnership have been harassed by their colleagues. 

Not everybody is so hostile to the training of “associates”. The former health minister and current member of the House of Lords, Jim Bethell, says medical professional bodies are bullies similar to those he experienced when facing down drug dealers while working at the Ministry of Sound. He dismisses doctors as “selling false narratives about patient safety” and describes medical concerns as really “old-fashioned professional jealousy and shop-floor protectionism dressed up in fancy clothing”.  So there you are!

Source: Rachel Clarke https://www.theguardian.com/commentisfree/article/2024/jun/20/physician-doctor-reckless-experiment-nhs-associates

Waiting lists on rise, private admissions too 

Despite claims that the backlog is now falling, waiting lists in April 2024 increased to 7.57 in the first month-on-month uptick since August 2023. It is an increase of around 34,000 from the previous month (March 2024) and a rise of around 157,000 compared to the previous year (April 2023).

The latest Private Healthcare Information Network (PHIN) data on private healthcare admissions reveals that there were 898,000 admissions to private hospitals in the UK in 2023 – an all-time high – while the number falling out of the workforce due to chronic health issues has risen to a record 2.83 million.

Source: www.templebaradvisory.com

Weight loss in the high street

Superdrug has expanded its face-to-face weight loss services with the launch of a new weight loss blood test and the introduction of Mounjaro into its high street health clinics to support patients with an eligible BMI in losing weight. Mounjaro is a weekly self–injectable pen containing tirzepatide. which works by regulating blood sugar. Prices start from £215 for a four week course, which will be available in over 80 of Superdrug’s Health Clinics across England, Wales and Scotland. 

Abolishing outpatients

Greater Manchester Integrated Care Board is planning to decommission secondary care outpatient clinics and replace them with primary and community care services. An anonymous commentator in the Health Service Journal caught an NfN mole’s eye.

There are lot of things that would need to happen to even make the concept work:

1. Enough space in primary care to accommodate sufficient clinical team to make an impact
2. Enough patients to fill a whole clinic on a regular basis, patients who can and are prepared to travel
3. Infrastructure such as the pertinent notes and clinical information being available *reliably* in clinic
4. Specialist kit which (may be) required for clinics to be shipped out/back
5. Access to investigations to support clinic and clinical decisions
6. Somebody to pay for the additional one hour (on average) travel time to/from said clinic (i.e. two hours lost clinician time) per clinic

Sounds good and patients might like it, but realities are complex and rarely cost effective.

Source: Mimi Launder ICB plans to ‘decommission outpatient clinics’ Health Service Journal

12 June 2024

Little Pharma

Some NHS Hospitals use ‘aseptic units’ to manufacture injectable chemotherapy drugs and other medicines in a sterile environment, often customising them for specific patients. The cancer-killing drugs often have short shelf lives and on-site preparation is frequently used to reduce waste and expense. 

The Royal Surrey Foundation Trust has resorted to buying pre-prepared cancer drugs from alternative suppliers since its aseptic unit closed in January. The cause seems to be due to water leakage, and the cost of drugs made elsewhere runs (excuse the pun, ed.) to £3 million a year. Another aseptic unit in the South East was found to have three “critical deficiencies” by the NHS Specialist Pharmacy Service - a leaking roof, unsuitable storage conditions and a raised risk of contamination.

Who knew the NHS made its own medication? The NHS spends around £4bn a year on injectable medicines, mostly of the chemotherapy type. In 2020, Lord Carter of Coles proposed a hub and spoke production system, with regional hubs, potentially run by companies, producing large-volume standardised products, while spokes — in sites like cancer centres — making personalised, bespoke or very short-lived medicines. 

Given the supply chain problems that the NHS now experiences, why are we waiting?

Source: Alison Moore ‘Hospital forced to close sterile unit after leak’ Health Service Journal  11 June 2024

Remote Triage

Technology used by telemedicine provider Consultant Connect enabled the triage of over 1,000 referrals at Kettering General Hospital in fewer than two months The project reduced the neurology waiting list by over half, from 1,001 to 491, providing a template for other NHS Trusts to safely cut into their own backlogs. This breakthrough comes at a time when more than 230,000 patients are on neurology waiting lists across England, waiting on average 17 weeks.

Patients were removed from the waiting list onto an alternative pathway or returned to their GP with a treatment plan. Other patients were accepted for a routine appointment or fast-tracked if they needed an urgent appointment.

The project used the clinical expertise of NHS neurologists in the Consultant Connect’s National Consultant Network. Once Kettering General Hospital’s local clinical lead had briefed them on the pathways available to them, they reviewed the waiting list remotely.

This resulted in hundreds of patients being returned to their GP with a management plan.

 The tech in numbers:

• All 1,001 patients on the waiting list were successfully triaged in less than two months

• 510 patients (51% of patients who were triaged) avoided an unnecessary referral

• 20 patients (2%) were fast-tracked and given an urgent hospital appointment 

• 471 patients (47%) were accepted for routine appointments and directed to the right place first time

The project has proven so successful that it has since been permanently rolled out at the hospital. Specialists from the National Consultant Network now review referrals coming in through the front door to help prevent backlogs from forming in the first place. 

Source: https://www.consultantconnect.org.uk/

Read more News from Nowhere and articles on the NHS in ERA 3 at http://www.healthmatters.org.uk/