After nearly six weeks of lockdown, parts of the NHS are now starting to resume elective activity. While this is great news for all of us, we are faced with the challenge of working through a large backlog of patients requiring treatment. This raises three important questions:
1. What does the backlog look like?
2. How are we going to manage the backlog?
3. When will we get "back to normal"?
1. What does the backlog look like?
For a typical outpatient department, the number of patients awaiting first treatment (incomplete pathways) will have grown by around 40%. This is the result of:
The backlog of patients that existed before lockdown
Patients who became unwell during the lockdown, but didn't seek treatment or weren't referred until elective services resumed (the "COVID-19 backlog")
Business as usual (BAU) demand that continues to arise since service resumed ("BAU patients")
The chart below shows how these three elements combine to create an unprecedented challenge.
For this trust, the number of patients waiting over 18 weeks is projected to increase from 1,700 to 2,600 and the number waiting over 52 weeks from zero to 300. This baseline view assumes that capacity remains equal to last year, but this is an optimistic assumption given the likely increase in acuity and follow-up appointments resulting from longer waiting times as well as further disruption caused by COVID-19.
2. How are we going to manage the backlog?
Our analysis suggests that traditional measures, such as waiting list initiatives (WLIs), are unlikely to make a significant dent in the backlog.
For example, a WLI that increases the total amount of weekly clinical time from 2 days to 3 days for a month will have the following impact on the baseline:
A year after the WLI, 18 weeks waits would be reduced to 2,100 and 52 week waits to 200, both still significantly higher than pre-COVID-19 levels.
Another way of managing the backlog is to adopt new ways of working, a digital model that is based on insights from operational data and responds to bottlenecks as they arise. Such a model that effectively utilises digital consultations can increase throughput and reduce DNAs, effectively increasing capacity on a permanent basis.
If this type of model could improve throughflow by just 10%, then it would have this impact:
This would reduce the overall waiting list, and the number of 18 weeks waits to pre-COVID-19 levels within a year. 52 week waits are projected at 150, which could be managed through a WLI.
3. When will we get "back to normal"?
The answer to this question depends, of course, on how we manage this challenge. Not only do WLIs have limited effect, but asking our NHS workforce to work yet harder following the COVID-19 crisis is neither reasonable nor realistic. Improving the way we work, building on the best of existing data and digital technology, will help both the wellbeing of our workforce and the quality of services for our patients.
This is where we would like to help! If you would like any of this analysis tailored to your department or trust, then please get in touch (we are making this freely available). If you are interested in adopting new digital ways of working that are quick to implement and cost effective, we can help.