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The mystery at the heart of the National Health Service

IT IS DINNER in Milton Keynes, and a young woman comes around after the operation on the vocal cords. Her breathing was monitored during the operation so she was awakened carefully, surrounded by blue-scrubbed doctors. A chronic smoker, she emits a series of hacking coughs and tries to clear up accumulated mucus – and the doctors are once again exposed to diseases she may have.

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Throat surgery is known under a recently popular acronym: it is a AGPor Aerosol Generating Procedure. The whole point of ear, nose and throat surgery, says Hamid Manji, Milton Keynes University Hospital’s clinical director of surgery, is to “root out the mucous membrane of the airway, whether it is the pharynx, be it the nose or in this case the vocals”. It releases viruses, which is a problem during a pandemic.

Lots of this kind of surgery stopped last year. Cinemas are now being thoroughly cleaned between procedures and patients must isolate themselves and take a covid-19 test before arriving. The result is a huge backlog. Across England and in all specialties, more than 5.1m operations are waiting to be carried out, the longest list since records began. And the wait is getting longer: nearly 400,000 of these operations have been planned for more than a year, up from 1,500 odd before the pandemic.

These numbers tell only part of the story. About 4.6 million Fewer people completed optional treatment in 2020 than the year before, as patients avoided their GPs and hospitals closed to all but the most uncomfortable. The trend has not abated this year (see chart). No one knows when or in what condition and how many of these missing patients will eventually show up. But it is certain that a year without treatment has taken a toll.

All this makes politicians nervous. “The public fully understands that the cause is now covid,” says a senior Tory. “The hardest thing to explain is that [waiting lists] will continue up. “Sajid Javid, the new Secretary of State for Health and Social Care, has begun preparing the ground and warns in an article about Mail on Sunday that the backlog “gets much worse before it gets better”. The last time queues were so long, under Tony Blair’s Labor government, the poll found that no question bothered voters anymore.

In the early 2000s, Mr Blair tried to cut waiting lists by raising inflation-adjusted health care spending by at least 6% a year. Boris Johnson’s government has so far pledged £ 1.2 billion. ($ 1.7 billion) Extra, less than 1% of the health care budget before the pandemic. More is expected in the next expense review, which is expected later in the year. At that point, the true length of the queue should be clearer. So must the ability of the health service to get through it. “We need to identify how fast we can go,” says Chris Hopson, CEO of NHS Providers representing hospitals.

One requirement will be to increase capacity. England has fewer CT or MR scanners pr. person than any other European country, for example, money has been set aside for 44 new community diagnostic hubs in the next financial year. It was to free up equipment for patients in hospitals. Additional covid-19 funding enables hospitals to recruit local private providers. But the hope is that the health service can also become more efficient.

“They now call us bones R Us, ”laughs Krishna Vemulapalli, a surgeon in East London. Last year, his hospital ran a “bone week” to see how many joint replacements could be performed in seven days, and to identify bottlenecks. Across six theaters, ten consultants worked from 8 to 20. An additional porter ensured that there was no downtime between patients. Lunch breaks were staggered. The goal was 100 joint replacements; they managed 135, with most patients going home the same day. The hospital has also tried a “gut feeling week” (to maximize endoscopies) and is planning “ENT 3.0 ”(three times the normal number of ear, nose and throat surgeries).

The bone lumen was an extreme example of “high volume, low complexity” (HVLC) surgery. The approach originated in London and helped explain why the capital has been quicker than elsewhere to cut waiting lists. The surgical process is divided into steps, from before patients arrive at the hospital to their recovery, with hospitals benchmarking against the top 10% of the performers for results and effectiveness. Streamlining the simple things frees up time for more difficult operations. The health service now wants to spread HVLC across the country and across specialties.

NHS board papers promise “air cover” (extra money) to reward top artists and support criminals. Still, cash is not the only obstacle. Covid-19 remains another because hospitalizations eat up resources, cause employee absenteeism and precautions slow things down. “Even though it’s only five minutes to clean the outpatient consultation room, it’s five minutes on 20 patients, and suddenly you’ve lost an hour and a half,” says Joe Harrison, CEO of Milton Keynes Hospital.

Sir. Harrison credits free parking and coffee to all staff with Milton Keynes recruitment assistance. Across the country, however, employment problems will set limits to the recovery. Recruitment from abroad is becoming increasingly difficult due to global shortages, notes Siva Anandaciva of King’s Fund, a think tank. “You can start expanding training sites; you can start building medical schools like the government does, ”he adds. “But will it bear fruit between now and the end of Parliament? Probably not.”

Recovery is also not the only task that hospital managers face. A new NHS Bills released on July 7 require them to move forward with plans to move health care out of hospitals and better integrate it with social care. “I spoke to a CEO,” says Mr. Anandaciva, “and he said,“ I feel like I have two jobs: one is to go after the biggest optional backlog in two decades; the other is to make the biggest transformation shift in how healthcare is planned and delivered in 20 years. ‘”

In fact, reforms introduced by Labor in the early 2000s to deal with waiting lists are now being undone. Even with a focus on waiting lists and plenty of cash, it took Labor the best part of a decade to reach its goals. Few expect a quick resolution this time, but a date is significantly large. “Leaders in the health sector know that ministers will be focused on the next parliamentary elections,” Mr Hopson said. The government came to power and promised to protect NHS. Any failure to do so will be punished.

This article appeared in the British section of the print edition under the heading “The Mystery at the Heart of the NHS”

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