How to battle the treatment backlog

Digital tools and data offer a way to reduce the UK health system’s 6.4M person treatment backlog, write Abhi Shekar and Rob Neave.

One in nine people in England are on NHS waiting lists after more than two years of COVID-19 disruptions to UK health services. The pandemic didn’t create the problem. Cancellation of medical procedures and delayed diagnoses, capacity constraints and staff burn-out have created huge pent-up demand for healthcare.

More effective use of digital technology across the NHS – to manage capacity and to integrate health and social care – will be essential to tackle today’s treatment backlog, but also to build future resilience.

There were 6.4M people on waiting lists in England across health categories in March 2022 – 52% more than the 4.2M people waiting for treatment in March 2020, according to NHS England. This includes 2.4M people waiting more than 18 weeks for treatment across specialisms in March 2022, 179% higher than the previous year.

In September 2021, the government pledged £36bn in additional funding for frontline NHS services over the next three years to boost health capacity, cut waiting times and provide support for the social care system across the UK. While this funding is welcome, major improvements in operational efficiency across the health system are needed just to get back to pre-pandemic waiting times.

Driving efficiency with digital

Effective data management and analysis can help. Digital tools can sift patient data across the entire health system, assess their health needs, prioritise patients most in need and then identify the right level of care and support needed for patients with lower care needs.

This means patients with the most urgent health needs, or those who have been waiting longest, can be seen first. Patients with longer to wait may be offered digital therapeutics, smartphone apps that can be used to monitor and manage symptoms or diseases, such as chronic pain, diabetes or depression.

Digital tools also offer the potential to manage waiting lists more efficiently by matching patient demand with latent capacity, wherever it is in the health system. This means that resources – such as beds, diagnostic facilities and operating theatres – can be optimised across all NHS Trusts without putting excessive burden on staff in particular locations. Either patients could be moved to different hospitals or resources could be redistributed.

In June 2022, it was announced that NHS patients who had been waiting for surgery for more than two years would be offered hospital treatment in other parts of the country – including travel and accommodation costs where appropriate.

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From hospital to home

Technology can also help to enhance patient wellbeing and aid recovery by reducing the amount of time that patients spend in hospital before and after a procedure or treatment.

Pre-assessment questionnaires and tests can be done efficiently outside of hospital and shared digitally with clinicians. Patients can also be monitored remotely in virtual wards using apps and wearable devices to check vital signs. This means that people can return home from hospital more quickly to recover, once it is clinically safe to do so.

Digital apps and videos with targeted exercises have also been shown to improve the physical fitness and resilience of patients before elective surgery or clinical treatment. This kind of ‘prehabilitation’ means they recover more quickly, have fewer post-operative health problems and use less health capacity.

Neighbourhood models of care

Shifting to neighbourhood models of care, where primary care is empowered and can enable the delivery of more health services, is another potential solution to the backlog. There are many procedures that could be carried out safely and effectively in a suitably equipped treatment room in a normal GP practice. This would allow hospital operating theatres to concentrate on the most complex and higher risk cases.

A lot of the workforce challenges the NHS currently faces could be alleviated by the vertical integration of services, with primary and secondary care working in partnership to deliver community-based alternatives to hospital care. Greater integration of resources would have to happen in tandem with the integration of services, however, as GPs currently lack spare capacity to take on more patient care.

With the right planning and support, neighbourhood models of care would open up more varied and interesting career progression opportunities to GPs and community health professionals in primary care. For example, intermediate care can offer temporary support to older people who might otherwise need to be admitted to hospital or residential care.

In the short term, greater integration of health with community and social care will present challenges. There would need to be a transfer of authority, skills and resources to specialist GPs and community health professionals.

The challenges of healthcare are often mirrored in the demand for social care. Faster turnover of patients through primary and community health centres will generate higher social care demand. Increased investment in the social care system will therefore be needed ‒ ensuring that medically fit patients are able to stay at home, or return home, with adequate social support.

A digital future

The COVID-19 emergency response showed that it is possible to collect and analyse health data from across the NHS in a timely manner. The lessons learned during COVID could help to drive better management of health data and inform decision making in normal times.

The COVID-19 pandemic also demonstrated what can be achieved when the health, care and voluntary sectors work together to organise care at the community level. This was particularly important for older people self-isolating at home during the first lockdown.

Stronger cooperation at a local level is now being formalised through integrated care systems (ICS), which became legal entities on 1 July 2022. ICS are well placed to build understanding and supportive relationships between the health, care and voluntary sectors, which has often been a barrier to progress in the past.

In addition, in April 2022, the UK government announced plans to develop a £240M Federated Data Platform, which will bring together multiple databases across the NHS under one common system.

If supported with wider investment in digitalisation, this will help the NHS to address bottlenecks and improve agility., putting it on a more sustainable footing for the future.

Abhi Shekar is digital healthcare lead at Mott MacDonald
Rob Neave is principal consultant for healthcare transformation and sustainability

How to battle the treatment backlog

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