What trust leaders need to tackle the backlog

In March, trusts were asked to create long term plans to tackle the waiting lists and care backlogs created by the COVID-19 pandemic. This planning work is being done alongside rapid work to treat the most urgent cases. Although much of the public focus has been on elective surgery and cancer care in hospitals, there are serious backlogs in mental health and community services that are just as important to address.

Trust leaders know how important recovering these backlogs are. They are as committed as anyone to ensuring no patient waits any longer for treatment than necessary. That's why last summer and autumn trusts put so much effort into restoring paused services, meeting the stretching targets they'd been set. They also provided more non-COVID care in December-February than in the first wave despite higher levels of COVID-19 demand.

In doing their mid to long term planning, trusts are hampered by the fact that they do not yet have the full picture of the scale of the impact of the pandemic on the health service. This means it is difficult to be precise at this stage about how long recovery is going to take.

But there are early indications that on current trajectories, it could take the trusts with the biggest backlogs between three to five years to get back to where they should be. We have been struck by how many long serving trust leaders are worried that the NHS is returning to the same position that we saw in the early 2000s - a time when the NHS had far too many people waiting for years on the waiting list. Having spent a good part of their careers working incredibly hard to solve that problem, those chief executives are adamant that the NHS must do everything it can to avoid history repeating itself.

The NHS will need increased physical and workforce capacity to tackle this size of backlog.

For trusts to be able to clear the backlog within a reasonable period of time, we need a team approach. The NHS transforming how it provides care and the government providing the extra funding required to enable that transformation. The NHS will need increased physical and workforce capacity to tackle this size of backlog. It will also need to tackle current pinch points such as diagnostics capacity. Trusts will also have to increase productivity and efficiency, often through improved collaboration.

Additionally, trusts will need to reconfigure to deal with future waves of COVID-19 and winter pressures without disrupting recovering backlogs. And, lastly, trusts will need to rapidly adopt new ways of treating patients specialty by specialty, such as using new technology solutions in ophthalmology where the waiting lists are some of the longest.

But the government needs to play its part too. Investment will be needed. A key part of the solution to tackling waiting lists in the early 2000s was five successive years of 7%+ real terms increase in annual NHS funding. This is more than double current plans. And there was a laser like focus on reducing elective waiting lists.

The present context is very different. There is a much wider set of NHS priorities such as the delivery of the NHS long term plan and living with COVID-19. We also know that there is a very different level of pressure on our public finances given the amount of money we have had to spend, as a nation, on dealing with COVID-19. But the NHS can only do what it needs to do with the right investment. That's why this year's extra, non recurrent, £1.5bn to start tackling elective waiting list backlogs and increase mental health capacity can only be a first instalment.

This blog was first published in the National Health Executive magazine.

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