Extra funding is welcome, but the NHS won’t be able to tackle the backlog without a radical upgrade in patient preparation and truly joined-up perioperative care

MPs yesterday voted to approve a new levy to fund the Government’s new health and social care reforms, estimated to raise £36 billion over the next three years.  The plan commits the NHS to drive forward ‘the biggest catch-up programme’ in its history, with a goal of delivering around 30% more elective activity by 2024/25 than before the pandemic. 

This is significant additional investment but estimates from the Health Foundation and others show that it is unlikely to be enough to return waiting lists to pre-pandemic levels by the end of this Parliament.  Meeting the Government’s ambitious elective targets, while still battling a pandemic, is going to require the NHS to spend this money on doing things differently.  We will never tackle the backlog sustainably and return waiting times to the 18-week standard without investing in interventions that radically change how patients experience the surgical pathway and how long they stay in hospital over the course of their operation.
End to end multidisciplinary perioperative care pathways not only provide better quality of care for patients, but they also:

  • reduce planned care length of stay in major surgery by 1-2 days on average without extra complications, unplanned readmissions, or extra burden on primary care or social services
  • reduce the rate of late or on the day cancellations
  • reduce time to surgery from admission
  • reduce time spent in theatre

All of these benefits are necessary to reach that 30% additional activity target the Government has just committed to. 

Despite a strong evidence base about the impact that perioperative care can have on the pace of elective care, these pathways are not yet core clinical practice and there is wide variation in delivery. This is a huge, missed opportunity for the NHS as it seeks to jump-start the elective recovery. We are now calling on the forthcoming elective delivery plan to include dedicated funding for the development of truly joined-up perioperative care pathways, with the patient at the centre. We stand ready to work with our partners across the system to support and drive forward this change.

Dr David Selwyn, Director of the Centre for Perioperative Care said:

"We welcome this new funding settlement and plan for the NHS and social care. The crisis in NHS waiting times and the crisis in social care are not two separate problems and we’re pleased to see dedicated funding for proactive discharge planning back into the community announced as part of the wider package of funding measures. We look forward to the white paper later this year for more detail on wider social care reform. 

When it comes to tackling the planned care backlog, the Government lays out a very ambitious goal for service recovery. But it’s clear that alongside this new investment, we need to embrace new ways of working. A key component of this is working with our patients in a joint-ownership model that encourages patient preparation for major surgery, utilising patient prehabilitation, smoking reduction and other lifestyle improvements, and other medical interventions. The NHS has a key role to play in the prevention of ill-health, and a focus on transforming waiting lists for surgery into ‘preparation lists’ will ensure that the elective plan reinforces the wider prevention agenda.  

Finally, money is not the only challenge. No matter where this new funding is invested in the system, it’s the same exhausted and stretched workforce that will be delivering the work. These reforms will not succeed if NHS and care staff continue to experience such high levels of burnout. We know that multidisciplinary working and the perioperative care approach improves job satisfaction - but we also know that too many NHS teams say that they lack the skills, training, time, and support to work in this way. 

We are now looking to the upcoming Spending Review to provide further details over how NHS and social care teams will be supported to rise to this three-year marathon challenge the Prime Minister has just laid out. As part of this, we urge the Government to commit to giving staff what they need to make multidisciplinary working a reality."

Lawrence Mudford, Patient representative at the Centre for Perioperative Care said:

“With millions of patients on the NHS waiting list, we welcome the extra resource aimed at clearing this unprecedented backlog. We know that many patients find their time on the waiting list to be alienating and confusing, and many go on to suffer deteriorating health as they wait for their operation.  We also know that many would like more support, information and advice and more communication with their healthcare team as they wait. 

Unless those issues are addressed, the largest catch-up programme in the NHS’s history risks leaving the patient behind. We will be looking to the forthcoming plans, due to be released in the Autumn, for the detail as to how patients will be supported during this time.”