UK: The NHS needs to ramp up treatment volumes if waiting lists are to start falling any time soon. 2022, IFS

The NHS needs to ramp up treatment volumes if waiting lists are to start falling any time soon

Institute for Fiscal Studies

Max Warner, Ben Zaranko

"NHS waiting lists have so far increased broadly in line with our past projections. We examine what this might mean for waiting lists in 2023.

NHS waiting lists have continued to rise this year, and in September 2022 there were 7.1 million incomplete waiting list pathways in England[1] . This is 60% higher than prior to the pandemic in February 2020 (4.4 million), and 17% higher than at the end of 2021 (6.1 million). Tackling this backlog of care is a key priority for the government and the health service. Here, we review our earlier projections for NHS waiting lists and, in light of their relative success, consider what those projections imply for the evolution of waiting lists over the coming year."

more at link: https://ifs.org.uk/articles/nhs-nee...waiting-lists-are-start-falling-any-time-soon

Twitter thread: https://twitter.com/user/status/1592424821417455618

 

An aside, but does anyone know what happened in 2007 to cause that impressively vertiginous drop? New Labour had been fretting about patient pathways for a decade, did it take that long for target-setting and increased spend to have an impact?

 

Easy to ramp up NHS treatment volumes - use the 'take 2 aspirin and if it's not better in a month then come back for 2 more' approach, that has always been traditionally skitted.

Of course, for an increasing number of things, they use the same approach, but don't even give any aspirin.

 

I think the answer is partly 'yes there was a significant delay in impact of increased spending' - however real terms spending (as a proportion of GDP) didn't increase markedly until after the 2002 election - yellow line in this graph https://www.nuffieldtrust.org.uk/chart/a-history-of-nhs-spending-in-the-uk

 

Cheers.

All suggests that even a sane and competent government working at pace won’t fix the current mess until the 2030s.

 

There are a number of structural problems that make 2022 substantially more challenging than 2002. The age pyramid of the UK population is shifting upwards meaning the overall burden of illness is increasing, despite various measures of health in older age actually improving.

A further effect of an aging population is the shifting of an increasing burden to a smaller younger population, something expressed in the Old Age Dependency Ratio (OADR)- the UK has actually seen that ratio reduce in the last 20 years as many more women enter the work place and a liberal migrant policy saw large numbers of younger people move into the UK. The former of these effects has largely played out, and post 2016 immigration has changed in a number of ways see Chart 5 .

The OADR isn't just important for the tax take, it also gives some measure of the National availability of employees who can be part of the NHS and care system work force - this is further departure from 2002 where NHS vacancies were in the 2-4% range while they are now 8 - 11%, against a backdrop of Global health professional shortages.

There is also the (consistently under recognised) obesity pandemic and not just children - now 28%+ adults

Against this backdrop it's likely to get increasingly difficult to the ME/CFS voice heard in the UK.

 

But they've known about the fact that the UK was tending to a situation where one paperboy would need to pay enough tax for support 4 million pensioners for donkeys, it was old news when I was at school over 40 years ago - and it appears that no one has done anything about it, apart from make it worse, but both keeping people alive longer, and by not paying paperboys a few billion a week so they can afford to support the rest.

Which is odd, as politicians tend to be old enough to have concerns about pensions etc., but I suppose rich enough to not have to worry about state support.

 

Well apart from hoping UK women were going start having many more babies (as opposed to going to work to pay bills) there was a fix - which was allowing large numbers of young mainland Europeans to come and live here with citizen level rights and other encouragements to contribute long term, however that solution fell out of favour.

 

So, back to your first suggestion, then. The sunlit uplands of Gilead it shall be!

 

I remember a cousin of my father’s who was a senior civil servant then and an aged life peer now, saying over fifty years ago that to sustain the NHS every suitably qualified school leaver would have to train as a doctor or nurse by the early 2000s, but that no ministers would seriously address this. The only reason things have not yet collapsed has been immigration.

Many countries now need immigration, for example in Russia the demographic time bomb is even worse, some estimate within ten to twenty years there the lack of engineers and technicians will see the collapse of the necessary infrastructure for modern life. Presumably the war with Ukraine through premature deaths and with young men leaving the country to avoid conscription will accelerate this for them.

It’s hard not to feel pessimistic about this, and no amount of politicians posturing will get round the fact that an aging population needs more health and social care.

 

I don't know about outpatient services, but until they can get medically fit people out of hospital, nothing connected to inpatient treatment is likely to change.

People are getting stuck for weeks and even months because they need some kind of support at home. There aren't nearly enough carers to support the existing population of elderly and disabled people, let alone those who might only need help for a time whilst they recover. Even though my late mum's carers worked for a decent company (chosen because it paid the living wage), they still had no real career structure or company pension. And even the living wage isn't really fair remuneration given the level of skill involved, and some of the personal care tasks they have to do.

As far as I can see the government seems to have shelved the increase in National Insurance contributions, which was eventually supposed to put more money into the care system. I think NICs were probably the wrong vehicle, as only people of working age are subject to them whereas both they and better-off pensioners pay income tax, but at least it was a start. In the short term I can't see any way to crack this particular nut without more funding and easier pathways for immigrants who would like to work in the UK.

 

Indeed, meaningfulness is an issue. It is now impossible to compare like with like due to the insertion of 'must send to physio, IAPT, tell to lose weight' or any other inserted stage which hides someone basically waiting by them sitting on that waiting list or watch and wait or 'treatment' instead of being on the actual waiting list.

What happened to the days of someone has something, it gets diagnosed and added to waiting list and whether said person ever gets the correct treatment is 'the outcome', rather than 'put somewhere, given anything'. No wonder transdiagnostic is becoming popular in certain areas, as long as you don't have a diagnosis then it doesn't exist as an issue other than what you decide to call that lowest common denominator blob

 

I'd need to check out these facts but when mentioning Russia I believe that their schooling has meant that there are generally more students who are very good indeed at maths in particular but also sciences vs the UK. Granted that isn't the same as being engineers but is a pre-requisite which is useful if you have, a major hurdle if you don't.