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How Will the UK Address the Mounting NHS Surgery Waiting List?

New measures introduced to support millions of patients waiting for surgery

The NHS is struggling to cope. The number of patients requiring surgery is now at record levels. The total backlog is 5.3 million, as revealed by the new Health Secretary Sajid Javid earlier this month. This is nine per cent of the UK population. The figure includes 400,000 people whose operations were postponed as hospital staff struggled to cope with coronavirus cases.

In a third of the hospitals in England, more than one in 10 patients have been on a waiting list for more than a year. In some hospitals, the number is half that, a BBC survey found.

18 weeks waiting time increased to 52 weeks

The 18-week waiting time promised by the Blair government back in 2007 has been shot to pieces. Instead, thousands of people have been waiting more than 52 weeks.

Of these, 620,003 people with arthritis are waiting for surgery. Over 90,000 have been waiting for more than a year for an operation such as a hip or knee replacement. These orthopaedic surgeries have been the worst hit during the pandemic, unlike cancer, which has seen a minor drop in surgeries performed.

In cardiology, a total of 242,181 people were waiting for invasive heart procedures, including heart surgery, at the end of May. That is another record. Of these, 52,484 or one in five patients had been waiting more than 18 weeks. A total of 4,252 had been waiting for more than a year.

Nearly half a million people (476,000) were waiting for an endoscopy procedure in March this year. In February, 6,109 cancer patients waited more than 15 weeks to be seen at the hospital – double the number for the same period in 2020. One in ten mental health patients has been waiting more than a year to be seen by a health professional.

To help tackle the crisis, the UK government has set aside £1 billion specifically for elective surgery to cut waiting lists. These funds will be spent on offloading patients to private surgery providers. But the backlog is so large that NHS watchdogs warn the money will be spent within six months. They insist it will take up to five years to clear waiting lists across the different surgery disciplines.

Government introduces new surgery referrals framework

Private hospitals that undertake NHS referrals will do so under a new government directive known as the Increasing Capacity Framework (ICF). Previously private hospitals were given funding for the use of their facilities. Today’s deal sees them being paid per the number of patients they treat.

To be considered, independent healthcare providers must be pre-approved before being placed on the government’s list. They must also undergo an approval assessment procedure every six months.

Hospital pilot programs to accelerate operations

To further speed up surgery, the government is introducing pilot programs in twelve areas of England and five children’s hospitals. They have invested £160m in what they refer to as “elective accelerator sites”. These will include pop-up clinics near people’s homes and high-volume cataract services. Evening and weekend surgeries are also part of the plan.

The Royal College of Surgeons (RCS) has called on the government to introduce at least one ‘surgical hub’ per integrated care system. They say the hubs could separate elective surgical services from emergency services and, in so doing, allow operations to continue safely even in the event of another pandemic outbreak.

More patients may go abroad for treatment

UK patients can still have treatment in Europe, Norway, Iceland, Liechtenstein and Switzerland, paid for by the NHS. This is provided they meet the criteria of the government’s S2 (planned treatment) route. The EU directive also allows them to “buy healthcare” in a European Economic Area (EEA) country, then have the cost reimbursed when they return home.

Foreign entities, particularly from the USA, may also influence the NHS soon. That’s because a new Health and Care Bill, which is presently passing through parliament, recommends powerful local Integrated Health Boards, with representatives from the private sector and care companies.

US firm Centene is likely to be involved. So too is Babylon (a digital firm part-owned by America’s Palantir). Virgin is also believed to be a contender.

Finally, many patients may decide to skip the line and pay for private surgical treatment. There is no shortage of choice in the UK, from established hospitals such as BMI Healthcare to upcoming US private healthcare organisations such as Cleveland Clinic London.

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