wLast week the NHS released its 18-week performance numbers, and we seem to be still heading in the direction of ascent, with now over 4m patients. The approach to such a significant waiting list now must be a daunting situation for any NHS trust to be in. With over 4.01m elective patients waiting for surgery, 4.4% higher than March 2018 and 6.1% than this time last year, we need to start looking at this challenge in more detail.

How does the NHS waiting list compare historically?

Is the waiting list out of line with the amount of activity processed in the year? Well, 5 years ago the waiting list was 2.75m, so 46% more, yes indeed 46% greater than this time 5 years ago. Upon reviewing those numbers, what was the total level of treated patients in the year for 2013/14 year vs 2017/18 year? The overall surgical interventions declared by NHS England was 11.0m vs 11.9m. So an increase of 10%, with an average of 919k surgical interventions per month to 991k per month in April 2017/18 year, 7% more treatments. However, based on the 46% increase in the waiting list this does not answer the question.

The waiting list has increased significantly but what else could be affecting the throughput?

So what other factors can Med Tech look at which will help pinpoint the problem? Well, in most industries you have a production line, which comprises of main elements which in most cases translate to healthcare, such as:

• Large number of machines = Theatres and recovery
• Large number of workers = Clinicians, nurses and hospital staff
• Variation to production = Winter pressures and increase demand
• Extensive inventory of consumables = Med-Tech – Pharmaceuticals
• The machines and equipment setting will have to be adjusted and re­adjusted to the manufacturing requirements = Different operations in the same theatre
• Movement of goods = Patients in beds.

Has the production line been affected?

What can we compare to the impacts on the NHS which might contribute to the 46% increase in waiting lists? Well, in the period of Qtr4 2013/14 vs Qtr4 of 2017/18, there were:

• 516,967 night beds available in the NHS vs 543,797 beds in Qtr4 2013/14 – 4.9% decrease

Looking at this in more detail, we have moved from 86.3% occupancy to an 88.2% in 2017-18 – 1.9% increase. The day-case beds have on the other hand increased from 47,821 in the same period to 49,732 (3.9%), so is that a sign of the change in treatment patterns? ( See our article – Has daycase treatment changed in the last 5 years)

We have also increased the number of theatres in the same period from 3,137 to 3,212, however, is a 2% increase enough?

The data indicates a reduction of beds and a slight increase in theatres, so clearly this will have an impact on the throughput. However, if there is nowhere to put the patients, then you cannot also start new patient treatments from the 4.1m waiting list.

So, if technology can shift patients away from theatres and the need for a bed and treatment can be delivered in Outpatients or ambulatory setting, then is this where the future lays for the NHS? Do tariffs cover the treatment setting and technology costs? Will that be considered when paying hospitals as new technology is not typically covered?

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