On Wednesday, he was among those presenting at on online conference examining the ‘Next Steps for Tackling NHS Waiting Times in Scotland’.
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It came as the Institute for Fiscal Studies warned that Scotland’s post-Covid NHS recovery is “lagging behind” England’s, and a day after the latest statistics from Public Health Scotland revealed that there were a record 38,373 people on the inpatient and day case lists who had been waiting over a year for their procedure.
One year waits were supposed to have been “eradicated” by September 2024 under targets announced by the Scottish Government back in July 2022.
Year-on-year, they have gone only one way instead: up.
National Treatment Centres (NTCs) – dedicated elective hubs dotted around the country – were designed to clear the backlogs by providing standalone facilities separate from acute sites where patients could be admitted for planned operations such as hip and knee replacements, or outpatient tests and scans.
By 2024/25, the NTCs were supposed to be delivering an extra 25,000 inpatient and day case procedures, but most of the hubs are currently on hold.
The two which have opened – in Fife and Highland – delivered 4,545 extra operations in the six months from April to September this year.
He said: “A number of national treatment centres have recently been opened across Scotland to provide additional capacity, particularly in the area of orthopaedics waiting times.
“These NTCs are already having an effect and we expect they will have more of an effect in the next few years.
“However, based on our projections, we think that, looking at a period of five, six, seven years ahead, the capacity may not be quite sufficient to bring waiting times down to the target levels as it stands.
“The NTCs on average bring in about 10,000 additional patients per year, but that will probably not be enough to bring the waiting times across the country down to the levels that the NHS is aiming for.”
But perhaps it depends what the NHS aims for?
Under Scotland’s Treatment Time Guarantee, no patient should wait longer than 12 weeks from referral for treatment to undergoing that procedure.Up until the end of 2015, at least 95% of patients were operated on within this timescale, but thereafter it began to fall away.
This puzzle of declining NHS productivity also cropped up during the conference.
Mark Dayan, of health think tank the Nuffield Trust, noted that many countries – including Ireland, Canada, and England – had suffered the same “mysterious drop in productivity” as Scotland since the pandemic in the form of outpatient attendances and hospital admissions despite significant increases in health expenditure and staff numbers.
There were several “commonalities”, he said.
Higher levels of sickness absence now compared to pre-pandemic and workforce expansion being led by increases in more junior, less experienced staff are likely contributors.
A rise in the average length of hospital stay, which in Scotland has climbed from around six days pre-pandemic to seven now, is also important.
People are spending longer in hospital partly because it is “more difficult to discharge into the community” – reflecting social care pressures – and partly because “population health grew worse during the pandemic”, so patients are sicker and more complex.
This comes on top of a system that went into the pandemic “operating on the edge of capacity” with far fewer acute beds than most European countries.
Scotland had around 2.4 acute bed per 1000 people as of 2021, compared to 5.8 per 1000 in Germany.
Mr Dayan said: “What we find is that there is a set of distinctions and characteristics in those countries, which may may suggest how it’s possible to have a lower length of stay and therefore pass more patients through even while you have a low bed base which should, in theory, mean you are only admitting people close to peak acuity.
“[Scandinavia and the Netherlands] spend a higher proportion of their budgets on non-inpatient care.
“That includes outpatients – not just hospital versus community or mental health.
“The implication that greater community capacity in the long term may help to speed progress through hospital, and enable higher throughput for the number of beds, seems to be borne out.”
But what about shorter-term fixes?
Dr Catherine Labinjoh, a consultant cardiologist and the Scottish Government’s current national clinical advisor for realistic medicine, said cutting waste would be one way to increase the funds available to the NHS for its frontline priorities.
She noted that medicines waste – money spent on prescribing medications that go unused, or partially used – is costing NHS Greater Glasgow and Clyde alone £100,000 a day.
Furthermore, she said 14% of patients who undergo general surgery – especially older patients – ultimately regret it due to complications.
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At the forefront of every clinician’s mind when advising patients whether or not to have treatment should be the acronym ‘BRAN’: what’s the Benefit; what are the Risks; is there an Alternative; and what if we did Nothing?
Reducing unwarranted treatment would translate into shorter waiting times, lower costs to NHS, and less harm, she added.
It should be a win-win – but in a health service under strain, perhaps there is a risk that “realistic” will start to look like rationing.
