Just two weeks after being diagnosed with cancer, John Harvey was in a hospital ward on Thursday for a three-hour operation that he hopes will cure him.
Harvey, 79, from east London, expected an anxious wait for treatment after being diagnosed with bowel cancer, but has benefited from a push to cut waiting times at the London trust where he is being treated. “I thought the wait would be weeks and weeks,” he said. “I was suprised.”
Harvey, who was in hospital for an operation to remove part of his colon, and millions of others like him are on the front line of a key election battleground: the NHS waiting list.
Rishi Sunak said last January he would improve the NHS, promising that “waiting lists will fall and people will get the care they need faster”. The waiting list is 330,000 longer than when he made his promise.
Sunak and Labor leader Keir Starmer clashed over the NHS waiting list during the ITV election debate on Tuesday, when the Prime Minister claimed waiting lists were shrinking. Starmer responded: “(They were) 7.2 million when you said you were going to take them down. There are now 7.5 million. I would like you to explain why that is.”
Shadow Health Secretary Wes Streeting says a new Labor government in England will create 40,000 extra appointments, scans and operations per week to reduce the waiting list, amounting to more than 2 million extra appointments per year. Still, one important question remains for the millions languishing on the list: Will it work?
Medical teams at King George Hospital, part of the Barking, Havering and Redbridge University Hospitals NHS trust, where John Harvey was treated last week, are already implementing some of the innovative measures that could ultimately reduce waiting lists. The hospital is in a neighboring constituency to Streeting’s, and he has highlighted their work as “truly groundbreaking and nationally leading”.
The aim is to prevent cancellations and ensure that medical resources, from operating rooms to diagnostic equipment, are used effectively. Or, as one director of surgery put it last week: ‘to sweat resources’. There is also more weekend work and collaboration with independent healthcare providers to ensure faster diagnosis and treatment.
Scheduled surgeries, known as elective surgeries, are routinely canceled in hospitals across the country because high-dependency beds are unavailable or surgical teams and operating rooms are needed for emergency admissions. The delays flow down the lists.
Thangadorai Amalesh, divisional director of surgery at Barking, Havering and Redbridge University Hospitals NHS Trust, said medical teams have been looking at the best ways to avoid cancellations during the pandemic. “We decided to create what we described as a hospital within a hospital, where we protected King George Hospital in our trust as a center of choice,” he said.
The new dedicated hub was set up with gated beds, facilities and staff. It meant that patients could be admitted without fear of their operations being canceled and surgeons could start their operations earlier in the morning, knowing that a high-dependency bed would be available for the patient afterwards.
The clinical teams looked at different aspects of their activities, with different projects to increase productivity. It included ‘bones’ weeks to tackle backlogs of orthopedic patients, with theaters open 12 hours a day on weekdays and weekends.
“The answer is never bureaucracy, but rather attention to how you remove bottlenecks in the system,” says Amalesh. “We have learned many lessons from the pandemic about how to be more flexible.”
The standalone choice hub set up at King George Hospital during the pandemic was one of the first to be established. There are now around 100 across England, mainly focusing on high volume, low complexity operations.
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The King George hub expanded last month with the opening of a £14 million extension, including two operating theatres. It makes 100 additional operations possible per week. The trust has reduced the number of patients waiting more than a year from 2,430 in March 2021 to 1,783 last March, and officials say they could have reduced this to zero had there been no industrial action.
Despite this success, the latest figures show that overall waiting lists at the trust are still rising over the year, highlighting that inpatient operations only make up a small proportion of the overall waiting list.
Matthew Trainer, chief executive of the trust, said: “This will not be a quick fix. It’s a recovery program. Nine out of ten people on the waiting list are not waiting for an inpatient surgical procedure. They are waiting for appointments and diagnostics.”
Independent providers are helping to assess patients following GP referrals, and there is a push from the trust to increase the number of clinics and tests. Trainer said further initiatives could be introduced nationally to check whether people on the waiting list should be on it or if they could be better treated in the community. He also said more investment in public health is needed to ensure healthier lifestyles and thus reduce the burden on the NHS.
Kathryn Marszalek, senior analytical manager at the Health Foundation, said Labour’s pledge of two million extra appointments a year should not in itself be seen as a “magic bullet”. “The healthcare system is in dire need of capital investment, and the industrial action involving junior doctors must be resolved. We cannot rely solely on trying to increase activity with one feature, such as weekend work.”
Labor plans to reduce waiting list times with weekend clinics, tap into spare capacity in the private sector and double the number of scanners to make faster diagnoses. It says the plan will cost £1.3 billion, paid for by a crackdown on tax avoidance, but it is a small part of the annual NHS budget for England of around £165 billion. So far the party has given no indication of the amount of money it is willing to spend on repairing crumbling hospitals or increasing the workforce.
Rob Findlay, a specialist in NHS demand and capacity planning at data management solutions company Insource, said the NHS carries out 92 million outpatient appointments, tests and operations every year, including follow-up appointments. The two million additional appointments per year promised by Labor represent an increase in activity of only about two percent.
“This additional activity should be aimed at reducing waiting times and the waiting list,” he said. “It will certainly make a difference, but how big the difference is is the big unknown.”