Oli Hudson, content director at Wilmington Healthcare, considers the ongoing impact of the elective care backlog on the NHS, why it is still the main issue for customers – and why medtech companies can be part of the solution.
At Wilmington Healthcare, we’re still talking about addressing the elective care backlog. Why? Because everyone with a stake in the NHS is: patients who are waiting for treatment, think tanks, clinicians, managers, transformation leads, industry – and politicians.
Since our print article for Med-Tech Innovation on the subject last month, the elective recovery plan was finally released by NHE England – putting some aims, policies and money behind what is surely the biggest challenge for the health service this year, the next and perhaps for several more after that.
Before we get into the details, it’s worth reconsidering exactly why this is the cause of so much concern. The plan states that because of the pandemic, with people unwilling or unable to come forward for diagnosis and treatment, 6 million people are now on the waiting list, up from 4.4 million before the pandemic – a figure that shows the NHS had a serious issue with elective waits even before COVID.
About four in five are waiting for treatment that does not require an admission to hospital, such as diagnostic tests and outpatient appointments. But that last fifth – often cardiology, cancer, and neurology patients – require inpatient or critical care stays, and the beds, staff and resources are simply not available to serve those groups.
Another concern is ‘missing patients.’ It is estimated that over 10 million patients who might otherwise have come forward for treatment did not – and in the worst-case scenario, if they all came forward, we would be looking at a waiting list of some 14 million patients.
The plan concedes that the numbers waiting will increase for another two years before they finally reduce.
What does the Plan say?
The plan has an ambitious agenda – cautiously welcomed by the likes of NHS Providers and the NHS Confederation – to attempt to deal with the backlog, with targets including:
- Waits of longer than a year for elective care should be eliminated by March 2025 and of longer than two years, by July 2022.
- 95% of patients needing a diagnostic test should receive it within six weeks by March 2025.
- By March 2024, 75% of patients who have been urgently referred by their GP for suspected cancer are diagnosed or have cancer ruled out within 28 days.
- Outpatients’ waiting times to be reduced by transforming the model of care and making greater use of technology.
How it intends to do this rests on two central propositions:
- Increased activity – the aim is 30% more elective activity by 2024/25 than before the pandemic
- Transformed services and new models of care.
This plan explicitly states that it is the recovery plan for acute and hospital services, and that primary care, community care, urgent and emergency care and mental health services are being addressed by other teams, and in other plans.
What it does not explicitly state is that these problems are interconnected – with the secondary care backlog causing primary and community care to have to manage the patients whose condition is often worsening – not to mention primary care’s role in screening and diagnosis.
Social care is affected too, both in its management of waiting patients in care homes, and in receiving increased numbers of discharged patients. Mental health services have their own crisis as waiting takes its toll on patients’ depression and anxiety, and urgent care is seeing increasing admissions too – what happens when what should have been elective suddenly turns into an emergency.
So, all parts of the NHS are affected by this – which is why it makes it a crucial issue for medtech to deal with.
How the backlog impacts on the new medtech value proposition
The increased emphasis on patient throughput because of the backlog means that this needs to be front and center in the medtech value proposition. Suppliers should question what the overall impact on backlog numbers are because of maintaining or switching a device. This question can be tackled in several ways.
Speed and ease of use
Medtech should consider the efficiency improvements associated with the intrinsic features and benefits of their product, and what is the data that can be used to support this – how many more patients can be operated on or otherwise treated because of speedier procedures and reduced theater time? It is notable that robotic surgery will see increased investment according to the plan, for example. Put bluntly, does your product allow the NHS to increase activity?
Creation of more streamlined pathways
In some cases, for example TAVI technology, an innovative method of treatment can lead to an entirely new pathway that not only improves outcomes from the intervention but improves throughput as previous inpatient stays can be done as day cases.
Ability to be used by a different staff mix
Does the device need supervision or direct use by a consultant – whose time is now highly compromised – or can it be used by other members of the theater team, allowing a trusts’ staff to operate more efficiently or flexibly? How would the product work in new models of care, such as in surgical hubs, which might have a different inventory, technical staff, space and working environment?
What is the impact on recovery and will the use of the product lead to increased discharge speed, creating extra capacity?
Reduced revision and complication rates
How reliable is the product in these areas, and would a switch likely lead to fewer such additional episodes?
Perhaps especially of note to wound care manufacturers, can products enhance healing of both trauma wounds and hospital-acquired pressure ulcers, reducing extra bed days due to this?
How does the product allow patients to self-manage after the elective intervention and what will be the real-life benefits of the procedure – will it allow them to live a life that in turn reduces pressure on the backlog in other parts of the health and which system? The plan also specifically calls for additional investment in technology to improve patient experiences of care and help patients manage their conditions.
Speedier and more reliable diagnostics
If you work in diagnostics, be aware that the plan calls for more investment in mobile diagnostics for cancer, upgrading MRI and screening technology, not to mention the establishment of 100 community diagnostics centers. Will your diagnostic test or device be usable in these settings by CDC staff, and does it fit in with what the NHS is trying to do here?
The market for backlog-busting technologies will grow as the government spends more than £ 8 billion from 2022/23 to 2024/25, supported by a £ 5.9 billion investment in capital – for new beds, equipment, and technology. This is in addition to the £ 2 billion Elective Recovery Fund and £ 700 million Targeted Investment Fund (TIF) already made available to systems this year to help drive up and protect elective activity. Under the TIF, the NHS is investing in over 870 schemes across more than 180 hospital trusts to increase capacity through expanding wards, installing modular operating theaters, and upgrading outpatient spaces, and the aforementioned diagnostic enhancements.
New groupings of customers will also be on the horizon, as the private sector’s involvement in reducing the backlog is set to increase – and as the plan calls for the establishment of surgical hubs – which could potentially be spaces where innovation could flourish as they set up new methods of treatment both for specialist / tertiary services and high volume and high flow procedures.
The backlog and the ensuing recovery plan therefore present an amenable sales environment for medtech companies that can get their value proposition right.