The number of people waiting for care and treatment and the length of time they wait has grown dramatically since the start of the pandemic and the situation now feels more concerning and challenging, and across a greater range of services, than ever before.
The size of the elective care waiting list is the biggest since records began and we also have over 1.7 million people waiting for mental health care, with latest prevalence data suggesting many millions more would benefit from care if they were able to access it. We then have over 900,000 people waiting for a range of community health services, worryingly delays in answering 999 calls, conveying patients to hospital and ambulance handovers, as well as 12 hour waits in A&E and delays for urgent mental health care.
While current pressures mean trusts are finding it difficult to tackle care backlogs as quickly as they would like, the NHS is working flat out to bear down on backlogs.
Senior Policy Advisor (Mental Health)
While current pressures mean trusts are finding it difficult to tackle care backlogs as quickly as they would like, the NHS is working flat out to bear down on backlogs. Latest statistics, as well as our conversations with trust leaders, show they are making headway. Our new four part series Providers deliver: Tackling the care backlogs – a provider podcast series offers further valuable insight into how trusts and their partners are tackling backlogs and the pressures behind them, and the difference this is making to patients and staff.
The opening episode of our new series also seeks to assess how great are the challenges facing services and the targets that have been set. In the episode, the need to address backlogs inclusively is highlighted, bearing in mind the stark divides – particularly on race equality – exposed by the pandemic, with Dr Bola Owolabi, NHS England's director of health inequalities, underlining how imperative it is that we narrow the health inequalities gap.
One of the strongest themes to emerge from our conversations on backlogs is the importance of empowering clinicians to make decisions and take innovative approaches. This was one of the key elements Dr Clive Kay, chief executive, and Ranjeev Bhangoo, head of neurosurgery, at King's College Hospital NHS Foundation Trust picked out when explaining what enabled their neurosurgery team to carry out 750 more operations a year to prevent backlogs building, while ensuring patients felt as close to the neurosurgery team as before the pandemic. This was also the case for Dorset County Hospital NHS Foundation Trust's new orthopaedic outpatient assessment centre, which is seeing 31% more patients than before the pandemic and has reduced total waits by 52% and the number of people waiting the longest by over 90% to date.
Another great example of clinicians being empowered to take decisions and pursue innovation approaches is Northumbria Healthcare NHS Foundation Trust's work to deliver a 24 hour physio service.
Senior Policy Advisor (Mental Health)
Another great example of clinicians being empowered to take decisions and pursue innovation approaches is Northumbria Healthcare NHS Foundation Trust's work to deliver a 24 hour physio service and assess patients in their own home, rather than on the hospital ward, when they are well enough to be discharged. This is supporting people to get home more quickly and improving their experience and outcomes, alongside increasing the number of hospital beds available for new patients. A further example is the clinical hub in Yorkshire Ambulance Service NHS Trust's emergency operations centre, which draws on the expertise of 60 experienced clinicians to help to deliver the right care to patients first time, and in turn is helping the management of care backlogs and pressures on other services.
Another key theme has been the importance of collaboration, with the North West Bed Bureau being a particularly strong example of this in action. Providers of mental health services coming together has meant the area has more inpatient beds available to help deliver care closer to home and fewer people have to wait in general hospital beds or in the community. This has benefited 440 individuals so far and has had a wider positive impact on the health and care system's ability to meet demand and tackle backlogs more broadly. Collaboration is also at the heart of Bradford District Care NHS Foundation Trust's work with MIND Bradford and other local voluntary and community organisations to provide more intensive holistic support earlier to individuals and better meet growing demand for Bradford's adult community mental health services.
Similar work has been taking place in south London, where South London and Maudsley NHS Foundation Trust and a host of other partners have worked with diverse communities to understand their needs and the key barriers to these currently being met. This work has resulted in co-produced actions being agreed and implemented to better meet demand – helping to tackle hidden, as much as known, backlogs in the area. Actions include developing a virtual waiting room for children and young people, and having extra staff in GP surgeries to provide multi-disciplinary support to individuals sooner, helping to prevent them becoming more unwell and needing more complex care.
Harnessing digital to deliver services is another key theme, from our discussions with trusts about their work to bear down on backlogs.
Senior Policy Advisor (Mental Health)
Harnessing digital to deliver services is another key theme, from our discussions with trusts about their work to bear down on backlogs. The cardiac service at Royal Papworth Hospital NHS Foundation Trust's use of remote home monitors to manage the devices of thousands of patients has helped them spot and address any issues earlier and prevent them from becoming more serious, supporting the trust's wider efforts to meet demand and tackle backlogs. Wirral Community Health and Care NHS Foundation Trust children's speech and language therapy (SLT) team's work to upskill teachers to support children with their language, communication and social skills is another compelling example: taking a digital approach ensured this service could continue to be delivered and backlogs managed despite pandemic pressures. It has also meant more children's needs can be met and the SLT team can support more children with the most specialist needs.
It is striking how solutions-focused and creative services across the country are being in their quest to tackle backlogs, all amid significant pressures and major workforce shortages. Trust leaders are absolutely committed to bearing down on waiting times as quickly as possible, while ensuring the health and wellbeing of their staff is protected. With the right support, trusts, their staff and wider partners will be able to make the headway on backlogs patients and service users need and deserve.
This blog was first published by HSJ.
About the author
