Read all about it: back to the future with place-based care

I wonder how you get your news each day. I haven’t bought a newspaper in years, yet I read the newspapers everyday online – well at least those that are not firewalled. Indeed, one of these newspapers regularly updates me on how many articles I have read so far this year – apparently, I’m up to 540. I suspect that like many other people, I increasingly get my news from many different sources. As I drive to work, I have a news channel on my radio. I use social media to find and follow stories. Occasionally I will seek out the news on TV, if there is some major breaking story or catastrophic event.

Now you might be wondering what newspapers have to do with anything. Last week, colleagues at my hospital were given notice that we, along with other hospitals, might be featured in one of today’s newspapers. The focus of the story was to be on the large numbers of people still on NHS waiting lists and the time taken to see folk on these lists. 

Our communications team and the wider NHS communications folk dealt with how we might respond to what is published. I haven’t read the story yet as its published in one of the firewalled newspapers, and my local newsagent isn’t open yet. In any event, I dare say it won’t make good reading, albeit it covers an important issue.

I say this because of the often biased and ill-informed stories on the performance of the NHS which are becoming more and more prevalent. Like many other health service commentators, I worry about the proliferation of such stories being regularly published by the right-wing media. I imagine that today’s story was prompted in part by leaked NHS England documents last week that showed an unpublished national waiting list for people requiring community health services. The leaked documents reported that there were more than a million people, including hundreds of thousands of children, waiting for such services.  

Due to the impact of Covid and the pre-existing health inequalities, the current overall total number of people waiting for diagnostic tests and/or treatment is over 6.5 million. It is worth remembering however, that during the pandemic 750,000 patients were treated for the virus in hospitals and many more in the community. Covid hasn’t gone away. The latest spike, which appears to be plateauing now, won’t be the last. These spikes will keep occurring for many years yet, perhaps not with the same intensity, but they will keep on coming. I guess another reason for today’s newspaper story is the fact that Greater Manchester (where my hospital is located), Essex, and Devon all have the largest waiting lists across England.  Sadly, it may well be that the numbers of people requiring diagnostic tests and/or treatment is actually higher than the figure published. The numbers contained in that leaked NHS England report might well be an underestimation.

A recent report undertaken by researchers at the University of Birmingham, also notes the published figures could be an underestimation. They suggest that to eliminate all waiting lists by 2030 would require a year on year 8.4% increase in the number of elective procedures being carried out. To put this into context, it would mean increasing the number of procedures by 50% above pre-pandemic levels. In terms of money, the report suggests an extra £9 billion in funding is probably required. However, as we have seen with Boris’s 40 new hospitals, there isn’t the money to pay for the additional costs required for new facilities, staff and equipment that would be required to do this on top of the extra £9 billion.

It is not all grim news though. At the end of July, the many thousands of people in England who had been on a 104 weeks long waiting list was reduced to just a handful of folk. This was a staggering achievement. That work hasn’t finished and NHS organisations across the country continue to look for new and innovative ways to help deal with the waiting list backlog. Eliminating the 104 week list was made possible because of the way integrated care systems (ICS) operated together, instead of individual hospital trusts trying to reduce the numbers themselves. And that’s the rub for me. In singling out any hospital by name in newspaper articles belies the excellent work going on across ICS’s. I’m confident that these approaches will continue to make a difference to the lives of people still awaiting their care. In Greater Manchester, if one hospital is struggling, it becomes the responsibility of the whole ICS to find solutions and offer mutual aid where needed.

There is another element to these issues which I suspect the newspaper article won’t touch upon. Last week, in Greater Manchester we had nearly 1,000 general acute beds unavailable to be used for elective treatment. Their unavailability arises due to people who have no reason to be in hospital but who can’t be safely discharged because of a lack of social and domiciliary care. A thousand beds is almost a third of all available general and acute bed provision. We have to fix this problem, or the waiting list numbers are likely to continue to grow.

Back in the days when I did go out an buy a print version of my daily newspaper, I can remember my first child being born. We lived on a street that celebrated her birth. When things got tough there was always someone there to lend a hand, give some advice or just simply be there with us. This was community support, and a kind of support that I think we may have lost sight of. Hopefully the development of place and locality-based care will take us back to the future and stop many more people getting onto a waiting list in the first place.