Delays to surgery catastrophic for patients, as 200,000 now waiting more than a year for an operation

Government reforms to the NHS present opportunity but long-term planning still needed

Clinicians must be central to any NHS reforms

The Department of Health and Social Care (DHSC) this week published its white paper detailing major new reforms for the NHS across England. The proposals come as NHS England released its latest waiting times figures, which speak to the scale of the challenge that the NHS is facing in the immediate term as parliamentarians debate its long term-future.

The waiting time figures show that at the end of December 2020, more than 200,000 patients had been waiting more than a year for surgery – an increase from 192,000 in the previous month. Now more than 4.52 million people are waiting for an operation.

In a further demonstration of increased pressure, the number of patients referred to treatment within the 18-week statutory period declined from 68.2% in November to 67.8% in December – missing legal targets and halting improvements seen in the Autumn.

The white paper proposals will look to improve patient care by continuing the trajectory outlined in the NHS Long Term Plan. It will move towards more integrated, joined up care across community, primary and secondary care settings and reverse some of the 2012 reforms. The proposals would also see ministers granted more power to intervene earlier in local NHS decisions.

Responding to the white paper and the latest waiting time figures Professor Ravi Mahajan, President of the Royal College of Anaesthetists said:

“We welcome the reforms proposed by the Government. They represent a positive change in focus away from competition towards collaboration – something the College has long supported. We remain optimistic that integrated healthcare systems will deliver better, safer care, improve efficiency, and streamline care pathways to wrap around the patient.

“However, our optimism is tempered by caution. The NHS is still in the midst of the biggest crisis it has faced arguably since its inception. With the public health system undergoing transformational change at the same time, we are worried that reorganisation will take priority over recovery. Any attempt to rush the implementation of large-scale change risks diverting attention from providing safe patient care, and a realistic timetable for delivery must be set out and communicated to staff.

“Additionally, we were disappointed not to see a long-term financial plan for workforce outlined in the paper. Staff are exhausted, there are considerable staffing gaps across the system, and retention is poor. The integration of services should help the NHS become more financially efficient, but fundamentally it requires the right number of staff, in the right place, at the right time. We are currently a long way from those conditions being met.

“The governments’ white paper is a step in the right direction, but we must tread slowly. The benefits of changes will be lost if there is a disconnect with what local NHS services need - clinicians must be central to any reforms. Without tackling the core drivers of safe and efficient care, including long-term workforce planning, any re-organisation of services is likely to have little effect on patient care.”