Are The NHS Reforms Radical Enough?

Will the new radical reforms of the NHS announced this week be enough to fix the waiting list crises?

The NHS Waiting Times Crises

This is a real human crisis with more than 7.5 million (1 in 10) people waiting for treatment. 41% of people are waiting more than 18wks.

It is a tragedy as so many people suffer in pain and misery, fearing for their health happiness, and their lives.

A Radical Reform Plan of the NHS:

This week the NHS announced “radical reform” to address this crisis. Releasing a plan called the Elective Reform Plan. (If you want to read the full plan follow this link here🙂

The key changes amounted to:

• Expanding community diagnostic centres and small surgical clinics
• Making it easier for patients to choose their treatment. (Which has existed for 20 years.)
• And a new deal with private clinics. (“The 1st of it’s kind”, since the last one 25 years ago)

With the clear focus of “dramatically cutting waiting lists” as per Keir Starmers New Year’s message.

I applaud the emphasis on faster diagnosis and treatment closer to home. This is a genuine positive step in the right direction. These are things that genuinely matter to be people.

Are the NHS Reforms Genuinely Radical?

But are these reforms actually radical?

Er well actually most of these are expansions of existing schemes announced in the 2022 Elective Recovery Plan and the Core20plus5 initiative. (It should probably be noted than when the elective recovery plan was launched the NHS waiting list was 6.1million. So it wasn’t a resounding success.)

Indeed this is just the latest of several plans to fix the NHS (as I’ve discussed previously) and it is really debatable whether this centralised planed approach even works. Lord Darzi’s report in the NHS reads like a graveyard of failed plans and initiatives.

How Big Are The Reforms?

Ok so maybe it’s the scale that’s radical? Let’s look at the numbers: The plan is to reduce the backlog by 450,000 by next year.

But that’s out of 7.5 million, so by 6%.

Not insignificant. But it will take over 16 years to reduce that waiting list down to where it should be.

It needs to be low because if we are take on the challenge of prevention through early diagnosis: to be effective the waiting times need to go from years & months, down to weeks.

We simply can’t have an effective early diagnosis process if it takes 5-6 months to treat them. Fast treatment is ESSENTIAL for prevention. Not a nice to have.

Early Diagnosis Reforms

There also seems to be some confusion about numbers appointments, diagnostic tests and waits for treatments are NOT the same thing.

There was also much talk about increasing speed of diagnosis. This does help as it means that more people going to hospital need to be there.

But more scans also tends to mean more people diagnosed, not less. People often have other problems identified in tests. Whilst they frequently, may not have the condition they are being tested for. There is likely to be suffering from some problem that means they were being sent for tests in the first place.

Don’t get me wrong we definitely need more diagnosis, but it often works against reducing waiting lists.

But even that is a drop in the ocean the new clinics when fully operational will deliver 500,000 additional diagnostic appointments. Sounds a lot. But this is on top of the 24 million tests the NHS already does each year. So an increase of 2%.

Why Are The NHS Reforms Not More Radical?

So why is the NHS failing in delivering radical reform?

Reading the full report it becomes obvious: Rather than radical reform, there are a large number of incremental improvements to services.

There are no less than 75 things ‘To Do’. There is actually no plan how to implement these actions. All these will require additional new plans monitoring and targets.

So this is not radical reform. But a project management to do list to improve the existing system.

Sadly no matter how well meaning this type of top down reform often is, it distracts from making meaningful patient focused change on the ground. As it becomes about local systems proving they are jumping through the 75 hoops created by NHS England.

We DO want and need radical reform of the NHS, but if it’s going to happen it seems local systems are going to have to do it for themselves. We need to reconnect the NHS with the rest of our society to make it our NHS.

Conclusion

While the NHS’s latest plan includes positive steps, like faster local diagnosis and more community clinics, it remains an incremental update rather than a transformative overhaul. Reducing a backlog of 7.5 million by just six percent will not ease the crisis quickly enough, and the emphasis on multiple “to-do” targets risks becoming another top-down checklist. Addressing this crises will require local leadership and collaborative working to create patient-focused innovation, an approach this plan does not sufficiently deliver on.