The thriller on the coronary heart of the Nationwide Well being Service

July 10, 2021

IIT’S NOON in Milton Keynes and a young woman comes to after having vocal cord surgery. Her breathing was controlled during the operation so that she is gently awakened, surrounded by blue-scrub paramedics. As a chronic smoker, she gives off a series of coughing fits to clear the accumulated phlegm – and medical professionals are again exposed to whatever illnesses she may be carrying.

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Larynx surgery is known by a new popular acronym: It is an AGP, or Aerosol Generating Procedure. Hamid Manji, the clinical director of surgery at Milton Keynes University Hospital, insists on ear, nose and throat surgery “playing around with the lining of the airways, be it in the throat, be it nasally or in this case vocal”. This releases viruses, which is a problem during a pandemic.

Many of these operations were suspended last year. Now theaters are thoroughly cleaned between procedures, and patients are required to isolate and have a Covid-19 test before arriving. The result is a huge backlog. Across England and across all specialties, there are more than 5.1 million surgeries waiting to be performed, the longest list on record. And waiting times are getting longer: almost 400,000 of these operations have been planned for more than a year, compared to 1,500 before the pandemic.

These numbers only tell part of the story. In 2020, around 4.6 million fewer people completed elective treatment than in the previous year, as patients avoided their general practitioners and hospitals except for most of the sick. The trend has not weakened this year (see chart). Nobody knows when, in what condition and in what number these missing patients will show up at some point. But a year without treatment has certainly taken its toll.

All of this makes politicians nervous. “The public now fully understands that the cause is Covid,” says a senior Tory. “The hardest thing to explain is that [waiting lists] will continue to go up. “Sajid Javid, the new state secretary for health and social affairs, has started preparations and warned in an article for the Mail on Sunday that the backlog” will get much worse before it gets better. “The last one Time when the queues were this long under Tony Blair’s Labor government, polls showed that no issue has troubled voters anymore.

In the early 2000s, Mr Blair tried to cut waiting lists by increasing inflation-adjusted healthcare spending by at least 6% per year. Boris Johnson’s administration has so far pledged an additional £ 1.2 billion ($ 1.7 billion), less than 1% of the pre-pandemic healthcare budget. More is expected in the next spending review due later in the year. By then, the real length of the queue should be clearer. That should also be the ability of the healthcare system to survive this. “We have to find out how fast we can go,” says Chris Hopson, the executive director of NHS Providers, which represents hospitals.

One requirement will be to increase capacity. England, for example, has fewer CT or MRI scanners per person than any other European country, so funding was raised for 44 new community diagnostic centers in the next financial year. This should release devices for patients in hospitals. Additional Covid-19 funding enables hospitals to recruit local private providers. But the health service should also become more efficient, so the hope is.

“They call us Bones R Us now,” laughs Krishna Vemulapalli, a surgeon in East London. Last year, his hospital held a “bone week” to see how many joint replacements could be done in seven days and to identify any bottlenecks. Ten consultants worked from 8 a.m. to 8 p.m. in six theaters. An additional carrier ensured that there was no downtime between patients. The lunch breaks were staggered. The goal was 100 joint replacements; they managed 135, with most patients going home the same day. The hospital has also tried a “belly week” (to maximize endoscopy) and is planning “ENT 3.0” (three times as many ear, nose and throat surgeries as usual).

Bone Week was an extreme example of high volume, low complexity surgery (HVLC). The approach comes from London and explains why the capital has been able to cut waiting lists faster than other places. The surgical process is broken down into steps, from patient arrival at the hospital to recovery, comparing hospitals with the top 10% of service providers for results and efficiency. Simplifying simple things frees up time for trickier things. The health service now plans to spread HVLC across the country and across disciplines.

NHS board papers promise “Air Cover” (extra money) to reward top performers and support latecomers. However, cash isn’t the only obstacle. Covid-19 continues to be another as hospital stays consume resources, cases lead to staff absenteeism, and precautionary measures slow things down. “Even if it only takes five minutes to clean the ambulatory room, 20 patients take five minutes and suddenly you’ve lost an hour and a half,” said Joe Harrison, executive director of the Milton Keynes Hospital Trust.

Mr. Harrison credits free parking and coffee to all employees who helped recruit in Milton Keynes. Across the country, however, recruitment issues will limit recovery. Recruiting from overseas is becoming increasingly difficult due to global bottlenecks, notes Siva Anandaciva of King’s Fund, a think tank. “You can start expanding the number of apprenticeships; You can start building medical schools like the government is doing, ”he adds. “But will it bear fruit by the end of Parliament? Probably not.”

Recovery isn’t the only job for hospital managers, either. A new NHS bill released on July 7th calls on them to move forward with plans to move health care out of hospitals and integrate better with social care. “I spoke to a chief operating officer,” says Anandaciva, “and he said, ‘I feel like I have two jobs: one is getting the biggest electoral backlog in two decades; the other is to make the biggest shift in health care planning and delivery in 20 years. ‘”

Indeed, the reforms introduced by Labor in the early 2000s to deal with waiting lists are now being reversed. Despite its focus on waiting lists and big bucks, it took Labor most of a decade to achieve its goals. Few expect a quick fix this time, but a date is big. “Healthcare executives know that ministers will focus on the next general election,” says Hopson. The government came to power and promised to protect the NHS. Any failure to comply will be punished.

This article appeared in the UK section of the print version under the heading “The Secret at the Heart of the NHS”

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