Long Waiting Lists

I am of the age that I can remember during my training, when the waiting lists time for a hip or knee replacement were up to 2 years.

Tony Blair’s administration of 2000 introduced an eighteen-week target by which time a patient’s hip or knee replacement should be undertaken. The average waiting time for in-patient care in 1997 was 13 weeks falling to 4.5 weeks by 2009. The 18 week target was last achieved in February 2016.

Understandably, these targets could not be met during the Covid Pandemic but were not being met prior to it.

Waiting lists have tripled in size since 2009 with over one million people waiting for elective treatment, as of September 2022.

The pressure on the NHS is regularly reported in the press with long waiting times for admission via A&E. Ambulances queue for many hours outside A&E due to the lack of hospital beds. Although there is a growing population with ever increasing needs, the inability to move patients out of hospital beds, into the community care, “blocks up” the hospital. The knock-on effect of ambulances being stuck outside A&E is their inability to help patients calling 999.

As well as the problem with beds, the NHS is facing staff shortages, the shortage of specialist scrub staff in theatre is increasingly apparent.

The efficiency savings available to Tony Blair, by pumping more money into the system to incentivise additional capacity is no longer available.

To enable the reduction in waiting times from 2000-10 it was recognised there was a need to develop the work force. Enough people were needed, but also that they needed to feel supported and valued to enable to target to be achieved.

The NHS is the largest employer in England with 1.2 million full time staff. The Kinds Fund recognises the people working in the NHS are the greatest asset and are key to delivering high quality timely care. There has been no NHS workforce strategy since 2003. The funding squeeze between 2008 and 2018, combined with poor work force planning and weak policies have created staff shortages. In part due to the Pandemic, the current staff have been chronically overworked under enormously stressful conditions. Many Doctors and nurses lost their lives caring for their sick patients’ It was uplifting that so many people turned out to clap on the doorstep, but the long hours and stressful conditions have continued. Following the Pandemic, the nurses were offered a 1% pay rise which was increased to 3%. Doctors have seen real terms pay cut of 26% over the last 10 years.

There is an increased number of medical and nursing students in training. Given the current work climate with doctors and nurses striking, there are concerns about the retention of these newly qualified staff. There is of course a time lag between the start of training and qualification, which will not meet the current gap. Some of this staffing gap has been filled by trained doctors and nurses from overseas. This number has increased 27% over the last twenty years.

The waiting time shows huge discrepancy throughout the country.

Apart from the personal cost to patients in terms of pain and reduced function, it has been shown that waiting a long time for surgery ( hip and knee replacements), the outcome is not as good as it might have been if undertaken sooner.

We still have a superb health service with excellent emergency care. Unfortunately planned surgery is struggling.