Money can't buy elective backlog targets
Researcher
Yesterday, the Public Accounts Committee (PAC) published a damning report on NHS England’s attempts to reduce the elective backlog. This marks the most recent in a string of depressing health news, with resident doctors – previously known as junior doctors – on strike, corridor care now found to be a year-round phenomenon, and this year’s flu crisis feared to be the worst in years.
PAC’s report concluded that, with over £3 billion spent on reducing waiting lists and building elective care capacity, NHS England have fallen far short of targets. Yes, investments have increased capacity across diagnostics, elective surgery and outpatients, but they’ve failed to reduce waiting times – the actual goal.
This Government has pinned its success to whether it can fulfil its promise to “fix the NHS”. Consistently, they have equated fixing the NHS with cutting the elective backlog, aiming for 92 per cent of patients to be seen within 18 weeks of referral. Many have questioned the choice to relentlessly tie their success to this goal: not only does an effective, productive and sustainable NHS require action far beyond the elective backlog, history shows that making progress on this is an incredibly complex and expensive target to deliver.
Yesterday’s PAC report raises serious doubts over whether Labour will be able to deliver this tricky goal, as well as whether they are being “realistic about the immense effort” it would actually take.
The ‘why’ of these woes is disappointing, but not surprising: major reforms announced without plans for delivery or funding, an overfocus on hospital-based care, poor monitoring of progress, and seeing ‘digital’ as a silver bullet.
With the Autumn Budget around the corner, it is more clear than ever that billions more funding is not the solution to the issues the NHS, and especially hospitals, face. The Prime Minister last year promised that the NHS would receive “no more money without reform”, yet if reports are to be believed, more money is on the way.
Hospitals must no longer be seen as the activity that happens within the four walls of the building, they must become a service, defined around remote care and enabled by excellent communication infrastructure – as proposed in Hospital as a service. This would ensure the patients treated in the physical hospital are those who actually need to be there, with better outcomes for all.
Then, for the patients who do need to be in the physical hospital, it is essential that they move in, through and out of the hospital as efficiently as possible. This movement (or lack thereof) is known as patient flow. For too long more beds, more doctors, more funding has been seen as the cornerstone of good patient flow, but this is simply not the case.
Instead, the workforce of the hospital must be aligned with the actual needs of patients. This requires more generalist consultants, a seven-day discharge workforce, and more (and better trained) operational managers. These may not be the most popular recommendations, but Re:State’s research for Ending the patient gridlock found they are the right ones.
And supporting these findings, PAC’s report found that variable and inadequate management of transformation programmes has been a key cause of programme underperformance. These management failings took various forms, but indicate the same gaps in change management and operational management capacity that Re:State’s research identified.
Current efforts to transform hospitals are woefully underachieving, all while costs balloon, productivity stalls and patient satisfaction is at rock bottom. It is high time for Government to take a bold new approach, for the benefit of patients, NHS staff and the public purse alike. Instead of perpetuating a dysfunctional model, largely the same as that of 1945, Government must seize the opportunity to completely rethink the Hospital of the Future.