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23/07/2020

What has waitlist management got to do with Olympic swimming?

With the NHS falling behind on elective activity due to Covid-19 and waiting lists only set to get longer, we'll look at the innovative new approaches that can help get activity back on track.

If an Olympic swimmer misses a day of training in the run up to a Games, how far does their training schedule fall behind their keenest opponent? You think one day? So did I. But, WRONG. The real answer is two – not only has the swimmer who missed a day taken a step backwards in their conditioning, their opponent has gone forwards by a day; a net two-day difference.

I suspect this is more the proposition of a psychologist than that of a conditioning expert but the principle remains: if you have fallen behind in any field, continuing to work at your usual rate will only leave you behind. You have to work harder to catch up – whether a medal is at stake or the constitutional standards within the NHS. You have to change your approach to get ahead.

What has waitlist management got to do with Olympic swimming?

So how far behind has the NHS fallen on elective activity?

Compliance rates across all access targets for the NHS have been falling in the last year, driving longer and longer waiting times. In January of this year just 84% of patients had their routine operation within the expected 18 weeks.

Waiting times for treatments then improved in April. With Covid, there was drastically less elective activity going on – an average of 15% of the volume of activity in April 2019 across NHS Trusts.  The amount of activity being formally referred into hospital was even lower, in some cases much less than 10% of normal volumes and there has been many more patients than usual self-selecting to delay treatment or even visiting their doctor at the moment, for good reason.

 What we are not seeing at the moment, then, is the “latent demand” – referrals that under normal circumstances would have been made so the truth is published figures won’t give anything like an actual picture of how far behind we’re falling.

When you consider that we have an increasingly tired workforce (of superheroes, thank you), a population who are becoming increasingly nervous about accessing healthcare, and ever stretched finances – we have the very definition of a burning platform

 

What if we continue as we are?

Before the pandemic, the waitlist for elective surgery stood at 4.4 million. But now, we have a lot of catching up to do. The NHS projects that in a “pessimistic” scenario, this wait list will more than double to 10.8 million by the end of the year. 

This still seems optimistic. If a trust only manages to do 15% of its historic level of activity in a given month, the waitlist will have tripled in 6 months (so that’s by August). And, then, if you make the heroic and highly unlikely assumption that we can return to pre-COVID-19 levels of productivity by Feb 2020 (so 12 months in), the effective waitlist for an average trust will have grown by 4 times over the passage of the year.   

 

How do we get back on track? 

Regardless of whether the waitlist has grown by 2.5 or 4 million, or something even bigger,  working a little bit harder is not going to return services to acceptable levels (and, by the way, staff have been working heroically hard even before the current pandemic). 

Necessity is the mother of invention – we simply have to work differently. To return to the swimming analogy, we’re a body length down and struggling to cling on as we approach the final 50m length so what can we do to get things back on track?

In my next article, I’ll be looking at some of the most promising and exciting new approaches to elective service provision that we’ve been working with organisations across the country to introduce.

Author: Mike Meredith

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