The Sunday Long Read – NHS waiting lists

Six million and counting

For the first time in two years this week’s newspaper healthcare headlines focused on something other than Covid-19 (technically speaking, but it’s a start.) Of course i’m talking about the NHS waiting list in England surpassing six million people (i Newspaper 11/2/2022) up from 4.7 million people in April last year (BMJ). Of course there has been much handwringing and finger-pointing from the usual suspects, and of courseĀ  a large degree of national concern. By the end of the week the Telegraph asked, ‘Will the NHS waiting list problem ever be solved?’ I’d like to offer my suggestions.

Supply and demand; demand is always on top

There has to be a recognition that as it currently stands the NHS in England has a huge supply and demand problem in relation to providing many aspects of healthcare services. The barrier to increasing supply is mostly due to staffing shortages. We saw with the Nightingale hospitals that the government has no difficulty in building, and equipping NHS hospitals seemingly overnight, but what we also saw was an acute inability to safely staff them due to chronic staff shortages and inadequate workforce planning over the past two decades. The long term plan here primarily must be to increase the number of nurses and doctors that the NHS employs, which largely means increasing the number of nurses and doctors that the country educates and trains each year. The current infrastructure and status-quo is insufficient, and inadequate to meet the healthcare needs of the country. We must also move on from the mistaken fallacy that recruiting extensively from other countries is ethical or sustainable in meeting the staffing shortages.

The place to start (my advice is to start now or tomorrow morning…)

These are the 5 things I would do immediately (many more would take shape soon after):

1. Scrap the vaccine mandate fully – losing 77,000 NHS staff on top of the 44,000 social care staff dismissed in November is a political luxury that the country cannot afford. Apologise and offer them their jobs back and hope that they accept with a forgiving heart.

2. Incentivise the doctors and nurses due to retire within the next few years to continue working. 20% of Registered Nurses and Midwives are over 56. That’s over 100,000! Many will wish to retire and that’s fine they have earned it, however some would stay but current financial penalties for doing so are prohibitive.

3. Open up the university places and structures for student nurses, doctors, and AHPs to adequately provide a pipeline of the future workforce. The 300 student nurses that will graduate from my university next year will not touch the sides of the local workforce gaps. UK universities turn away so many suitable candidates due to imposed caps on student numbers due to funding or placement capacity.

4. Prioritise the types of services that are offered based on need, demand, and sustainability. The truth is that some well-resourced services really are not in the nation’s best interests to offer when many NHS trusts struggle to safely staff their ITU or A&E. The running and delivery of excellent public services has to be efficient and effective, whilst also being high-quality. It’s hard not impossible and we must stop making excuses for why we can’t do it consistently. Resources are always finite so there is a moral and ethical duty for healthcare systems to ensure that essential services are always high quality. If that comes at the expense of non-essential services, then that is a regrettable necessity.

5. Throw the full weight of a national recruitment effort behind filling all health and social care vacancies with people of the right values, and skills. We should give this the same priority as we would approach gaps in other sectors of national security and stability.

As Alan Weiss might say; ‘80% ready, go!’

And that’s it. I’m not the first person to suggest any of these solutions, all are already known and pretty obvious. The response to the Covid-19 pandemic has shown that England has the resources available at its discretion. In my mind at least, like most problems in life and business, England’s waiting list crisis will only be solved through good leadership and a commitment to adapt and execute.

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