I might as well make a clean breast of it.
I missed something.
On the 8th February, No19 made an oral statement to the House of Commons;
‘…[an]… ambitious Elective Recovery Plan, for tackling the COVID-19 backlog of elective care.’
It didn’t make a lot of sense.
Most Trusts are already at, or about, pre-pandemic levels of elective activity and as all the Covid numbers seem to be going north, it’s hard to see we aren’t heading for another major interruption.
Let’s hope I’m wrong.
Jiggery-pokery with Apps will make a marginal contribution and fiddling priorities will cause a row.
Anyway, here’s the bit I overlooked. No19 was schmoozing the back-benches with how much money he’d squeezed out of the Treasury and how…
‘… it will allow the NHS to perform … around 30% more elective activity, each year in 3 years’ time than it was doing before the pandemic.’
Read that again… tell me what it means.
- In three years time the NHS will be doing 30% more than it did five years ago?
- Each year, in the next three years, it will be doing 30% more than it did two years ago?
- Does it mean there will be no increases in performance for three years?
By the way, which year, before the pandemic, are we measuring from? It matters because the performance was already dropping-off. In July 2019 the waiting list size was estimated to be at 4.37 million and climbing.
If this plan was a map of Treasure Island, we’d be looking in Milton Keynes, Melton Mowbray, and Marlborough when we should be looking in Bognor.
No19 is a muddler and there appears to be no one in his circle that can either write a speech, do research or bring clarity of thinking…
… and he knows he won’t be Secretary of State for Health in three years’ time.
Let’s assume, what he is trying to say is; he’s got the money from the Treasury and expects the NHS to up its game by 30%, asap.
Why 30%? Where’s the evidence that that is achievable? Why three years from now? Or, does it start, incrementally from now?
Let’s park all that for a moment. Have a look at NHS productivity; inputs, versus outputs adjusted for quality.
According to the University of York’s Centre for Health Economics;
‘… [the NHS]… provided 16.5% more care, pound-for-pound in 2016/17 than they did in 2004/05, compared to productivity growth of only 6.7% in the economy as a whole.’
The NHS was 10% more efficient than the British economy!
Flat-line funding and the Covid pandemic has knocked all the numbers bandy. We have fewer staff and beds, per head of population than most of our EU and OECD comparators.
Between 2000 and 2015 the number of elective hips carried out, each year in England, was 78,430, increasing by about 4.8% a year.
However, in 2015/16 the number fell and fell again in 2017/18… a decrease of 0.5% over three years.
Why?
In short, patients receiving hip surgery tended to be older and in worse health… as patients post-covid are likely to be… growing demand and longer waits.
Here’s the question; how is the NHS going to improve productivity by 30%. Not just maximise capacity. It means add to capacity-max, by 30%.
For every 10 hip operations now, it’ll have to do 13, to keep up with demand and make a dent in the waiting lists.
It takes about two hours to ‘do-a-hip’.
Usually, operating lists are performed between 08.30 and 17.30. That’s nine hours and about four hips. Add another session, work to 20.30, as many Trusts are attempting and you have an extra two.
Uninterrupted, working seven days a week, that’s 42 new hips. We’re still 12 short.
Not all operating theatres are doing hips as there are knees, hearts, eyes, hernias and all sorts, that need fixing.
Let’s push theatres to the outside edge of productivity;
- Uninterrupted lists
- Cut preparation time
- Slash change-over time
- Standardised protocols
- Rearrange maintenance and cleaning
- Operate in shifts, 24/7
- Stratify patient risk, separating complexity pathways
- Extend clinical roles, train lower-band staff to undertake routine tasks in theatre
- Enhanced recovery programmes to push through-put
- Virtual follow up
… but who is going to do it?
Each hip session might have six core-team members. Work 24/7 and for one theatre, you’ll need 18 people a day, more if you add in rota, study days, days-off, sickness, teaching, outpatients and annual leave.
We don’t have enough people and won’t have, even in three years’ time.
And, the bigger question… why has the NHSE/I Board agreed to this?
Do any of them have a calculator?
News and Comment from Roy Lilley
Contact Roy – please use this e-address roy.lilley@nhsmanagers.net
Reproduced at thetrainingnet.com by kind permission of Roy Lilley.
