Whatever colour of goverment is elected today, it has promised increased access to care and a reduction in waiting lists. This promise, they say, will be materialised through increased funding and extra capacity. This capacity will be secured through additional payments to existing staff or purchasing capacity through idependent providers.
It is an obvious fact that waiting lists and waiting times have increased since the pandemic and the new goverment will no doubt form a view on how much additional capacity is required to achieve their stated goals and from where they might source it. But is this the right approach?
A significant hurdle is that they will have little understanding on what the NHS should be delivering with its existing staff. Take NHS consultants for example, it is estimated that they provide approximately 75-85% of all specialized medical care within the NHS. But does a Trust know whether consultants are delivering what they are expected to deliver. Twenty years ago, the DoH made job planning a contractual obligation to help Trusts manage their consultant resource better by asking consultants to describe their working week in scheduled or prgrammed activities (PAs).
But today, few Trusts use this information to forecast expected delivery and even fewer organisations monitor actual service delivery against expected delivery.
The result is that it is impossible to know whether there is a source of "in-house" capacity that is going untapped. There maybe good reason why actual service delivery is less than expected. Consultants are often interupted, they have to cross cover colleagues and patients do cancel or are not fit for procedures. But a Trust needs to understand these blockages and what amount of "in-house" capacity could be unlocked internally with a few operational adjustments.
If actual delivery is well matched to expected delivery and waiting lists are not reducing then extra capacity is inevitable. However encouraging existing staff with overtime is not likley to work if blockages to existing capacity are still there and external sources of capacity will be much more expensive than the costs of releasing "in-house" capacity.
The best way for the new goverment to bring down waiting lists is to better quantify what existing service delivery should look like and monitor whether the actual service delivery is living up to expectations. Only then can sensible decisions be made on how best to reduce waiting lists.
[1] 20consultants averaging 5 PAs is 100 PAs a week. Assuming all PAs in normal hours you would expect 400hours a week of reporting activity. 4 months is 1/3rd of the yearduring which you would expect 42 weeks of activity if all consultants take
their leave entitlement i.e. 20 * 5 * 4 *14 = 5,600 hours.