Introduction
On the second Thursday of the month, NHS England publish data relating to demand, activity, waiting times and national performance against constitutional standards and recovery targets across the secondary care sector.
On 11 July we issued our media response to the latest data. In this monthly output we take a more detailed look at national and trust level data across the acute, ambulance, community and mental health sectors. We track activity, highlight trends, bring together the insight of NHS leaders and frontline staff and explain sometimes complex waiting times data - one important indicator of patient experience.
We also explore the continued recovery of services in the context of Covid-19, looking at national performance improvement trajectories and trust level variation. Trust leaders and NHS staff know better than anyone that in some cases they are not currently able to deliver timely and high-quality care to every patient they see. At the same time staff are also working tirelessly to increase activity, a trend often observed in the data, with activity in some areas exceeding pre-pandemic levels. As the efforts to boost activity are often outstripped by even more demand, media coverage over the last six months has often focused on the slipping of performance against targets.
Sometimes more hidden is the improvement work that we know staff are driving at local level, making progress wherever they can. Each month we will therefore also feature a trust case study highlighting a recent change, initiative or innovation aimed at improving operational or clinical effectiveness.
Alongside our data dive, we will be tracking relevant political and policy announcements that impact the operational landscape of the NHS. The newly elected Labour government set out a range of manifesto pledges prior to the election, including a return to meeting NHS performance standards, and delivering an extra two million NHS operations, scans, and appointments every year. Within their first week in office, they have also announced an independent review of NHS performance by Lord Darzi.
Our view
Data published by NHS England in July, the week after the general election, sets out the scale of the challenge for the new government.
Urgent and emergency care has had the busiest six months on record, with sustained pressure and high acuity of patients putting more pressure on the pathway. Delays in transfers of care persist, both within the NHS and with other care settings.
Despite positive increases in activity across diagnostic, elective and cancer care, waiting lists are still increasing due to sustained levels of demand. These waiting lists are present across all sectors, with the community waiting list reaching a record high. Demand and activity in mental health settings are around 40% higher than before the pandemic, placing huge additional pressure on services right across the country. We are also seeing an increase in children and young people accessing these services.
This national level data tells the story of a health system under pressure and patients not always receiving the care in the way they need as a result . Our analysis also digs deeper, highlighting variation between trusts. Driving trust wide improvement and reducing unwarranted variation is a key focus for trust leaders and national policy makers alike.
Behind the data is a workforce pushing extremely hard to increase activity and drive improvements. There are examples of trusts, provider collaboratives and systems working together to make improvements.
Urgent and emergency care has had the busiest six months on record, with sustained pressure and high acuity of patients putting more pressure on the pathway. Delays in transfers of care persist, both within the NHS and with other care settings. Despite really positivepositive increases in activity across diagnostic, elective and cancer care, waiting lists are still increasing due to sustained levels of demand.
These waiting lists are present across all sectors, with the community waiting list reaching a record high. Demand and activity in mental health settings are around 40% higher than before the pandemic, placing huge additional pressure on services right across the country. We are also seeing an increase in children and young people accessing these services. This national level data tells the story of a health system under pressure and patients not always receiving the care in the way they need as a result . Our analysis also digs deeper, highlighting variation between trusts.
Driving trust wide improvement and reducing unwarranted variation is a key focus for trust leaders and national policy makers alike. Behind the data is a workforce pushing extremely hard to increase activity and drive improvements. There are examples of trusts, provider collaboratives and systems working together to make improvements.
We share more detail on these in our Providers Deliver series. This month we highlight a case study from East Suffolk and North Essex NHS Foundation Trust on robotic surgery - an example of trust innovation and the use of AI to improve patient outcomes.
Robotic surgery at East Suffolk and North Essex NHS Foundation Trust
Matt Tutton, consultant surgeon and the divisional director for surgery, gastroenterology and anaesthetics at East Suffolk and North Essex NHS Foundation Trust (ESNEFT) shares how robotic-assisted surgery has benefited patients following more than £10m investment in the technology across their two acute hospitals in Ipswich and Colchester.
Providing the best care for our patients is a given. We know the best healthcare is only possible if we continue to innovate and invest in the tools we use to treat patients, so we’ve made a large investment in robotics across our trust since 2020.
We know a procedure done robotically is less invasive, we know it helps improve patients’ outcomes and we know the length of time needed to stay in hospital is reduced.
All our colorectal surgeons at Colchester Hospital are now trained to use the Da Vinci robots for procedures, and all colorectal patients will now have their surgery done robotically. We are the first trust in Europe to reach this milestone.
As well as colorectal surgery, we’re performing urological operations and gynaecological surgery, including endometriosis procedures, with robotic surgery. To date nearly 1,600 patients have had their treatment robotically with the Da Vinci robot and more than 100 partial and full knee replacement using our CORI robot for complex orthopaedic operations.
Our patients have shared the benefits they’ve experienced first-hand. Amy and Abbie both had gynaecological surgery with the Da Vinci robot. Following years of pain, they’ve said their recovery following the operations was much improved from traditional surgery.
Patient Matt Farrell, was able to have a full knee replacement with the CORI robot. Matt said the operation has “changed his life” and he’s now able to walk comfortably and work again without pain.
Our Iceni Centre at Colchester Hospital is a unique centre offering a wealth of robotic training for surgeons and clinicians across the globe. We also know by investing in the technologies available to our clinical teams it helps them develop individually, and in turn it encourages skilled consultants, doctors and other clinical professionals to look at ESNEFT as a desirable environment to work.
Colorectal surgeon Arshad Malik is based at Ipswich Hospital and operates using robotics with the Da Vinci. He said: “As the robot is so precise, we are able to remove an additional layer of lymph nodes and tissues around the cancerous tissues, in turn improving patient outcomes and survival rates for colonic cancer compared to traditional surgery. It is also incredibly stable, which makes complex surgery easier and means the surgeon is less tired after a long operation.
"Robotic surgery is set to revolutionise surgical care within the next couple of decades, and it’s fantastic that ESNEFT is at the forefront of those advances. It is also really exciting for the surgical team to be part of this innovation, which will help us continue providing the highest quality care for our cancer patients which is on a par with centres of excellence in colorectal surgery."
We’ve had surgeons from Sweden visit to find out ‘what good looks like’, our robotic surgery was featured in the BBC’s coverage of the 75th birthday of the NHS and our colorectal surgeon and pan-European proctor Subash Vasudevan has explained how it works on the BBC’s Your Body Uncovered with Kate Garraway television series.
ESNEFT consultant orthopaedic surgeon Tim Parratt said: “It's great that ESNEFT has focussed on innovation for the future, particularly with regard to surgical robotics.
"As we build the country's biggest elective orthopaedic unit (ESEOC), this technology fits well. We are currently at the forefront using the CORI robotic device for knee surgery and are looking ahead to install more devices in ESEOC, including for hip surgery."
"Not only that, but we have been integral to setting up The Institute of Excellence in Robotic Surgery (TIERS) at Anglia Ruskin University. This institute will focus on world-class research and education on surgical robotics. Two of the current research areas are in robotic knee surgery."
"Hopefully these endeavours combined will deliver top-class clinical care to our patients across the region."
Our ambition for robotic surgery at ESNEFT continues to grow and we plan on expanding the specialities we use with the technology so we can treat more patient in the future. As Tim has mentioned, this year we’re opening a brand new elective orthopaedic centre (Essex and Suffolk Elective Orthopaedic Centre) at Colchester Hospital offering state-of-the-art care to patients from across our community and beyond. Robotic surgery will be a key part of this now and in the future of our trust.