Oli Hudson, content director at Wilmington Healthcare, explores where the NHS is with the elective care backlog – and what it could mean for industry.
It is clear now that the NHS acute care will face an unprecedented surge in demand after the COVID-19 pandemic eases.
Eight months ago, I wrote an article for Med-Tech Innovation about the backlog, which even then involved unprecedented numbers of patients.
Since then, we have had a third wave, and this crisis has become even more acute.
The BMA estimates that, between April 2020 and February 2021, there were 3.24 million fewer elective procedures and 20.07 million fewer outpatient attendances.
And it’s not just elective attendances that are piling up. The pandemic has also directly resulted in 1.2 million missed NHS Health Checks. These sessions bring in many patients onto heart, stroke and respiratory pathways, where the likelihood of managing conditions in primary care and the community are higher if the conditions are caught at the optimal time.
In just one clinical area, CVD, The British Medical Journal has concluded that the lack of these ‘preventive’ measures, in addition to a substantial reductions in cardiovascular activities, are likely to contribute to a major burden of morbidity and mortality. In the words of HSJ contributor Jules Payne:
“Reduced CVD care during the pandemic will mean acute CVD care after the pandemic… I believe that there is a real risk we could see acute hospital services experiencing a tidal wave of people presenting with strokes and heart attacks in the coming months and years.”
How will the NHS actually deal with all this? Health bosses say they need a "multi-year" plan to address the backlog, with chief executives urging the government to go beyond current targets. But is this going to be funded by the government?
The backlog, again according to the BMA, is potentially costing the NHS between £4 billion and £5.4 billion to work through. But the comprehensive spending review in November 2020, and subsequent treasury statements, announced just £1 billion to go towards clearing the backlog of elective care.
This falls far short of what is needed and this is where medtech may find the NHS a desperate customer. NHS Providers are calling for more hospital beds, medical equipment, doctors and nurses as well as vast improvements in diagnostics and trauma care if there is any hope of clearing it.
And while the new NHS planning guidance offers incentives for hospitals to restore pre-covid levels of activity, ratcheted up over the year as services come back on line, these extra funds will come out of that £1 billion recovery fund – there will clearly be a shortfall.
If there is any hope that the NHS will address this backlog, new approaches will be needed. For medtech there are several short-term effects of this that will have to be borne in mind.
Firstly, at least some of this additional activity is likely to be outsourced to private hospitals, particularly high-volume flows such as hip and knee replacements. This brings private hospitals into the medtech stakeholder map as far as NHS pathways are concerned.
Secondly it will also mean providers will have to reconfigure themselves. This is likely to include an expansion of initiatives such as the hot/cold differentiation in acute care as proposed by the GIRFT (getting it right first time) initiative – hot hospitals providing emergency care, and cold electives. This means some services will change location, with commensurate effects on staff, theatres, wards and patients.
Thirdly, expect a raft of service redesign that places care in the community, care at home, and within the responsibility of multi-disciplinary teams headed by a consultant, often working remotely, so acute theatres can focus on the patients most in need rather than host long-term conditions patients.
Fourthly, providers will be tasked by integrated care systems to undertake patient prioritisation exercises to take referrals where interventions can make the most difference.
In all, it will mean a long hard look at individual accounts and how their means of addressing the backlog will take shape – which trusts will face the most insurmountable obstacles and will need information, data, technical assistance, ideas, and partnership with industry.
The unprecedented backlog will take time – years – to clear: and medtech should aim to be a supportive partner in easing the NHS’ burden.
