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What have we go to thank ancient China for?
Duck-n-pancakes. Special fried-rice…
… silk, exotic spices, art, civilisation, mathematics, oh yes, and…
… calculus. Although the Greeks might give you an argument about that.
Originally called infinitesimal calculus… it’s a mathematical discipline and is very useful. It popped-up in the Middle East, medieval Europe and India.
Before I disappear into the weeds, in plain English, a really interesting bit of calculus says;
‘you get out what you put in’…
... the concept of ‘derivation’. A method of calculating the rate of change of a function with respect to its input.
What’s it got to do with the NHS? I’ll tell you.
About 1.6 million patients leave the waiting list monthly... sorted.
The Institute for Fiscal Studies says there’s an average monthly referral rate of 1.69 million. New patients joining the waiting list and has been since 2016.
Excluding Covid, it’s a trend that’s carried over into recent NHS performance statistics.
Why calculus is important is because it lets us figure out ‘the rate of change of a function with respect to its input’.
In our case, the ‘function’ is the blood, sweat and tears fabulous NHS people are putting into a day’s work and the ‘rate of change’… the impact all that has on waiting lists…
… sadly, not much.
Inflow: ~1.6-1.69 million new referrals per month, joining.
Outflow: ~1.6 million patients a month leaving.
In yesterday’s £walled Times, Charmer told us he’s set to make a speech about his ‘plan for change’. Rebooting his flaky start.
One of the changes [which was actually an election promise]; to reinstate the NHS target; 92% of people waiting for treatment to be seen in 18 weeks, or something like it, by 2029… the next general election.
As you can see from the numbers… it ain’t gonna happen…
... unless there’s a magical way to stop people getting sick, or a miracle in NHS performance.
Magic? The top users of the NHS are older people and youngsters, that means fixing social care.
Miracle? NHS performance… might be a better bet, but…
… we need to understand the difference between productivity and efficiency.
The NHS is efficient.
It deals with 1.6m new referrals month-in, month-out, that’s very efficient.
Charmer wants 92% sorted within the 18-week target.
That can’t be done…
… because that’s about productivity...
... which is constrained by capacity; 100,000 vacancies across the NHS, clapped out admin systems, a knackered estate and not enough beds.
However, thanks to a bit of calculus, we know; if we align with present treatment capacity and if waiting lists were reduced to around 3.5 million, the NHS could cope with 1.6m joining monthly and treat 3.5 million patients within the 18-week target.
This creates some head-room and safe bed capacity of around The Royal College of Emergency Medicine's recommendation that hospitals operate most effectively when occupancy levels are no higher than 85%...
... right now we are regularly over 95%
The question is, how to get the waiting list from 7.6m to 3.5m.
How do we blitz four million people off the waiting list. It will take money, that said...
How about;
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Appoint a waiting list Tsar. Make someone the focus of activity, accountable with the authority to make decisions and a budget.
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Do the maths; about 60% of the four million will need a diagnostic. Focus on getting that done, sweat the assets 24-7, where you can.
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Invest in machine learned, image interpretations (AI). They exist now. Up-skill radiologists and use them for high-end and close-call decisions.
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Of the 60%, about 20% will need a period of inpatient care. The rest will be day case. The day case rate for the NHS is currently 81%, try and push for another 4% to 85%, which is the target.
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Revalidate the list regularly. In December 2022, a consumer insights survey found that 22% of UK adults are now paying for private health insurance. They may initially have been on NHS lists, but since gone private.
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Deconstruct the list; show what people are waiting for and where. Separate diagnostics from in-and-out-patent waits, publish three lists.
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Recognise productivity is starting to tick up. It’s fragile, so stop the damage to morale done by Silly-Boy’s ‘the NHS is broken’, schtick. Over half of NHS people already do unpaid overtime.
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Understand, discretionary effort is a big part of productivity.
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Encourage flexible working and family friendly rota.
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Mandate the NHS to introduce minimum standards for facilities, working conditions and work scheduling across the NHS.
Do all that and; be nice, pray for mild winters, don’t goad staff into more strike action, avoid any kind of reorganisation...
... and with a bit of luck, by 2029, it might just be possible.
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