Exploring Labour's plan to tackle the NHS waiting list crisis - Part 1

The current challenges facing the NHS highlight that Labour's plan to reduce waiting lists is part of a much bigger conversation. In our two-part series, we’ll explore the impacts of the existing elective backlog and discuss sustainable strategies for better follow-up management and patient care.

Labour's goal of building an NHS fit for the future appears promising at first glance. There’s a lot of value in the overall Manifesto. Reducing waiting times and eliminating the backlog of patients is a goal we can all support. However, the ambition to create 40,000 additional appointments each week by extending clinic hours is the start of the conversation, not the entirety of it. After discussing with several clinicians, one question we see repeating itself is:

“Are these strategies missing the point by focusing too much on statistics and targets, without considering how the already overstretched NHS workforce will manage an increased capacity?”

The current state of NHS waiting times and backlogs 

While it's crucial to address the significant challenges within our healthcare system, we must consider whether the right issues are being prioritised. The sheer volume of patients waiting for treatment is staggering, with the backlog exacerbated by the COVID-19 pandemic. An extended delay impacts not only patients' health outcomes but also the NHS's operational efficiency. 

Of course, it's the right step to tackle the waiting list crisis. But what if we approached the problem from the inside out to reduce the issues instead of trying to add further strain through an increase in capacity? 

Rather than addressing the underlying issues that cause the backlog, the current approach is heavily numbers-driven, with an emphasis on reducing the visible waiting list. Which, in turn, has an ever-increasing knock-on effect on both patients and clinicians.

Patients are trapped in uncertainty

Patients often feel un-empowered within the current system. After seeking medical help and having their problems identified, they are frequently left in limbo, waiting for clear communication or updates on their situation. A lack of information and prolonged waiting can lead to feelings of uncertainty about what comes next.

The waiting period can extend for years, during which patients' conditions often deteriorate. By the time they are ready for an operation, their health may have declined to the point where they are no longer fit for surgery. Hearing you must wait even longer or that you’re no longer fit for a procedure is disheartening for patients. The constant uncertainty and lack of communication breed anxiety and feelings of neglect.

Many patients are feeling increasingly anxious due to their perception that the healthcare system is letting them down. According to the recent BSA survey, satisfaction with NHS services has reached an all-time low, with only 24% of the public expressing satisfaction, the lowest since it started in 1983. Patients believe their names are being removed from waiting lists to manipulate statistics rather than receive the care they need. Trust in the NHS is eroded as patients feel the system prioritises numbers over timely and effective care.

Clinicians already face overwhelming pressure

From a primary care perspective, the backlog creates a significant administrative burden and greatly impacts GPs' daily operations. Patients, frustrated by long waits and lack of communication, often turn to their primary care providers for answers. As a result, GPs must chase up secondary care providers and manage patients' expectations and anxieties, increasing their workload.

GPs often reach a point where they can do little more for patients once they have been referred to secondary care, leading to a cycle of relatively futile administrative work and patient dissatisfaction. The delay in treatment can worsen patients' conditions, making their eventual care more complex and resource-intensive, placing additional strain on an already stretched-thin NHS.

In hospitals, the focus on productivity and managing metrics can sometimes lead to inefficient resource use. For instance, some surgeons may be praised for their theatre time utilisation, even if the number of surgeries performed is low. A mismanagement of resources further exacerbates the backlog and delays in patient care.

Moreover, inefficient communication between primary and secondary care providers significantly contributes to the problem. The current system of communication, which relies heavily on emails and form-filling, doesn’t facilitate the quick decision-making needed to manage patient care effectively. Nor is it a task either clinician has the space for in their diaries. The mismatch leads to frustration for those trying to provide the best care possible under increasingly challenging conditions.

Unpacking Labour's plan

While Labour's plan brings hope, some of the delivery may compound existing problems. It’s easy to consider the NHS waiting lists as numbers and statistics, but at the core of the issue, we’re dealing with people. On one side, there are individuals who are sick and in pain. On the other, there are healthcare providers who are also friends, parents, and family members, striving to make a difference while battling the ever-present threat of burnout and its domino effects in their own lives.

Our already overstretched workforce is unable to extend clinic hours. Turning to premium-rate clinics will be a costly undertaking that will squeeze resources and lead to significant financial challenges. 

To truly affect the NHS waiting list crisis, it’s crucial to maintain a balance between ambitious targets and the practical realities faced by both patients and healthcare providers. While this initiative is certainly a big move in the right direction to address the NHS backlog, let’s take it a step further by addressing the root causes. Long-term change requires a comprehensive and sustainable approach that considers the needs and challenges of all stakeholders involved without asking more from our NHS staff.

The good news is that viable solutions that not only tackle the immediate elective backlog but also implement smart, sustainable follow-up management processes for the future are within reach. In our next article, we’ll explore the solutions that begin to address NHS challenges at their core.