The Backlog Introspective Part 1

The Backlog refers to secondary care services that have been severely disrupted by COVID-19 and the increase it had on the NHS’ list of patients awaiting treatment, surgery, and other healthcare procedures. Hospitals throughout the UK continue to face severe pressure. Over 7 million patients are stuck in The Backlog, but that’s just in England. The situation is dire and is putting immense strain on healthcare workers across England. This is the first of three articles that will look at The Backlog and unpack what has happened, the impact it is having on the healthcare workforce and what can be done in the future to reduce the number of people awaiting care.

The Backlog is not a problem that was caused by the outbreak of COVID-19. The Backlog had been a problem before the pandemic had happened and was already a growing concern. The Backlog was an indication that there were structural problems within the NHS which made it difficult for them to keep up with the amount of care patients required. However, the impact of COVID-19 turned a bad situation into a worst-case scenario being described as “off the scale” by one senior NHS leader.

In 2010 the NHS waiting list was the lowest it had ever been and when more money was invested into the healthcare sector the waiting list was almost non-existent, almost. The NHS introduced a rule in which patients had to be treated with 18 weeks of their referral. The last time this target was met was in 2013, meaning that The Backlog is almost 10 years old.

How The Backlog came to be in the first place is linked to GP referrals. GPs have patients on their waiting list for elective care. Elective care meaning any routine procedure that’s planned in advanced. Many of that GP’s patients come back to them and ask if they can help them get a hospital appointment. Some can wait as long as 3-5 years for operations like hip replacements. Leaving patients in a great deal of pain for a very long time. GPs would then refer new patients to hospitals as per their request and they all get added to a waiting list for the treatment they need. As that list grows those patients are added to The Backlog and treated patients are no longer on the waiting list. The more resources and funds available to the NHS and the healthcare sector, therefore, affects the number of people working for the NHS thus affecting the rate at which patients in The Backlog receive treatment. When the COVID-19 pandemic hit the UK the number of patient referrals has increased faster than ever seen before. Putting pressure on an already strained NHS system. This is how The Backlog became the problem it is today.

As you can imagine this puts the NHS staff and workforce under a great deal of pressure on top of the nightmare they were living through every day during the lockdown. Some patients have their surgeries and appointments cancelled at the last minute due to unexpected emergencies, double bookings, and several other reasons. This can even happen up to 2-3 times per patient which in turn also negatively affects staff morale as they are forced to continuously deliver disappointing news to patients in need. The reason the waiting list is so uncertain and why appointments are cancelled all comes down to problems with the data.

Unreliable data is a big headache for NHS bosses and is the result of a lot of cancellations and rescheduled appointments. People on the waiting list have died, but the number of deaths is unknown and very hard to track. People who skip appointments or do not come forward for their care also contribute to the problems with the data. There are also millions of patients waiting for follow-up appointments which is a separate backlog in its own right. There are also some hospitals that have not revealed the true number of patients on their waiting lists. The Backlog numbers continue to rise and no accurate way to confirm the status of every single patient awaiting care causes a lot of difficulties.

Pressure on NHS staff during Covid was enormous, but pressure on staff is nothing new, it’s always been there so it might not relate to supply and demand. It might be due to a political decision to run the system to its limits.

Finding a better way to deal with The Backlog will be difficult with both time and budget being an issue. Though the way forward could potentially be bright. There is no straightforward way of increasing staff availability. While EU recruitment has dropped off following Brexit, there is still currently a lot of new staff arriving from outside Europe. Registrations from overseas nurses and doctors each reaching around 10,000 in the last year of data. The sustainability of this will depend on political decisions about migration, the UK’s competitiveness, and ethical concerns about draining staff from poorer countries. Meanwhile, although medical training places have sharply increased during the pandemic, retention will remain a crucial issue. This may be put at risk by pushing staff too hard after the pandemic. Another concern comes from the latest staff surveys that shows the proportion of nurses considering retiring or leaving the healthcare sector has risen from 15.7% to 16.9%.

It has been estimated that it would be a 10-year project to get the waiting list back to 18 weeks. Some say it should be done by 2028 and others say it could only take 3-4 years. The government wants it to do a third more than pre-pandemic levels, but most say this is unrealistic.

There is one insurmountable obstacle in the way of The Backlog recovery, the current staffing crisis. Matthew Taylor: “Technology is going to have an impact in many areas for example diagnostics where it is possible to imagine a future where we’re not going to require the same number of people because technology will be able to do the job more efficiently. But whilst it’s important to do all of that, and that’s why we need a proper workforce plan which we haven’t got at the moment for the NHS, you can’t do any of that if you’ve got a very high level of vacancies”. Siva Anadacive says, “Technology is going to play a crucial role in tackling The Backlog and there are so many different examples of how, so there are some advanced firms that are using artificial intelligence to look at people on the waiting list and help you work out the best priority in which to see them.” Technology will help.

Keep an eye out on our website and social media platforms for the second part of this discussion. MCG Healthcare understands the impact The Backlog is having on the healthcare industry, and we go the extra mile to make sure the jobs we provide are the best we can provide. Register with us online to gain access to a dedicated consultant and the chance to apply for our broad range of healthcare opportunities.

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About the author
Ash Higgs Managing Director

Ash Higgs is the Managing Director of MCG Healthcare. He has a long-demonstrated history working in recruitment and has now been involved in the medical industry for over 5 years. During this time, he has gained a strong understanding of the issues that both Primary & Secondary Care are facing regarding the recruitment of healthcare professionals.

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