Right now all eyes are on the performance of the NHS and Covid. It’ll be many months before we catch our breath but my fear is, before we do, the next big push will come. Waiting lists.
There were about 4.4m people on waiting lists before Covid. Now… dunno. A lot more. The NHS had done a fantastic job, trying to run two systems; covid and non-covid. Cancer numbers are holding up but as for the rest, compounded by people not presenting during the pandemic? Your guess is as good as mine.
What to do?
Use the private sector? We need all the beds we can get but there are only about 515 private hospitals, in total, probably 8,000 beds? Most don’t have emergency facillities and if anything goes wrong they have to ring 999. Staffing is the problem. Usually, ‘their’ doctors are NHS doctors, moonlighting.
Anaesthetists, a vital component; there are 680 funded, but vacant posts, 8% of their workforce. Nearly 40% are over 50 and over 1,000 have reduced their hours due to pension-tax charges.
This is going to take some good, old-fashioned management to sort out and a bit of bravery from HMG.
For starters there are 20 things.
1 Validate the waiting lists, then do it again and again. We have to know how many, where and for what. Create a national dashboard.
2 Invite recently retired surgeons, anaesthetist and theatre nurses to come back and do some ‘Nightingale Shifts’. HMG… fix the tax system to make it worth their while.
3 Enhanced-recovery reduces length-of-stay to a minimum. Therefore, work with primary care to make sure waiters are as fit as they can be, pre-op.
4 Offer on-line Zoom physio sessions, think about organising waiting list buddies, mutual support. Let no one think they are forgotten and everyone know what’s happening, what to expect.
5 Get on top of pain control, it’s a critical factor. On-line clinics.
6 Write, email, the waiters every fortnight… let them know what’s going on. Where are they on the list. Give them healthy-living advice, keep them motivated and let them know they aren’t forgotten. Time, on solid communication, is cheaper than using time and energy dealing with failure-demand… aka, complaints.
7 Up-date MPs, let them know what you’re doing.
8 Recognises waiting-list management is an end-2-end process. From the car-park to discharge and everything in between. Start with the patient and work backwards… pick the process apart and make it as slick as it can be. Very Important Patient, exclusive waiting-list pathways.
9 Plan ahead, start with the discharge date and work forwards to plan discharge support and backwards to arrange the admission date. Focus on the discharge, even before the patient is in the car-park.
10 Increase capacity by expanding training. For example; train radiographers to administer barium enemas.
11 Digital-first policy for all outpatient appointments, where ever possible.
12 Forensically focus on every out-patient DNA… what is there to learn?
13 Maintain equipment at night, everything has to work all-the time, right first time.
14 Pool resources and capacity; make referrals to consultants in line with capacity, not lists. Share simple common procedures and amalgamate all admin functions in a hub. Instil a ‘how can I help’ ethos.
15 Pool similar treatments geographically. Regional cancer centres have really worked. Can you do the same for hips?
16 Preserve the flow, make sure patients are seen in date order… other than clinical priorities, queue jumping causes delays.
17 Time in the process means waiting, don’t waste it by doing things twice, repeating mistakes. Little things like, don’t take samples out of a bag, put them on a rack and then into the centrifuge. Go… bag-centrifuge and you’ll save 40mins a day.
18 Do all out-patient testing on the same day. Review everything you can on the same day. Avoid multiple visits.
19 Minutes matter, they accumulate, aggregate and are the difference between an admission today, or tomorrow.
20 Project manage every inch of what you are doing. Look for: benefits beyond helping patients; how nimble are the processes and how easy to change; how is the system monitored; if senior leadership buy-in to ‘minutes matter’ figure out ways to be sure everyone else does.
… but I’m sure you knew all that. So, don't say I didn't warn you... steady yer-self for the onslaught.
