The NHS is a technology laggard in a 21st century where businesses and organisations across the country, and indeed the world, operate digitally. While the pandemic means that we are relying on hard-working doctors more than ever to provide health services, the analogue processes of NHS often impose a tremendous weight on their ability to deal with patients smoothly and swiftly. The backlog for care is longer than ever before. More than 5 million Britons are currently waiting for a consultation or treatment, and that number is expected to double in the coming months.
A simple problem with the system is that patients are added to the waiting list in an unsophisticated manner. There is often little understanding of the granular detail and nuance about the urgency of their medical needs. In simple terms, it’s an ever-growing, often first-come, first-served conveyor belt. Instead, we desperately need to prioritise care based on better information so we can say more clearly who needs which doctor, and when.
Throughout the 13 years I spent as an NHS surgeon, I had the chance to observe the system’s unwieldiness up-close. But in reality, pretty much everyone in the country can empathise with patients’ helplessness as they’re endlessly bounced from one department to another in search of the right specialist or asked to wait agonisingly long for an appointment.
The root cause of this problem is a lack of communication between primary and secondary care providers. At its core, healthcare consists of a partnership between primary care clinicians (eg. a GP) and secondary care clinicans (e.g. me, an ear, nose and throat surgeon) for further examination and treatment.
This continual headache is caused by archaic referral processes between the two levels that still relies on traditional letters, emails, or other clunky forms of communication. Health Education England’s recent Topol Review showed that between 15% and 70% of a clinician’s working time can be spent on administrative tasks like sifting through referral letters. These bog doctors down and prevent the NHS from functioning to its best ability. The system is dangerously inefficient and comes at an astronomical cost to the taxpayer. Worse yet, these delays can have a fatal cost in cases that require urgent attention.
Many of the people waiting for treatment are doing so with pain, fear and anxiety. According to the Guardian, more than 600,000 elderly people with arthritis are on the list, all of whom will be in significant discomfort while they count down the days until they get help. Clearly, we need to fix the antiquated referral system before these issues are aggravated, and in doing so maximise the potential of the NHS to manage the patients in most urgent need.
Moreover, the first-come, first served ‘conveyer belt’ approach to the waiting list also masks the reality of the list’s demographic makeup. If you look beyond the sheer numbers, you will see that it is disproportionately comprised of society’s most isolated and vulnerable, people who are statistically much less likely to come forwards for elective treatment, and therefore suffer the worst outcomes even outside pandemic times. Understanding who is on the waiting list will therefore help address many of the broader health inequalities that are rife in our society.
What’s clear is that the opportunity for primary and secondary care to integrate through technology is huge. It would allow doctors to understand who is urgently in need of care, who isn’t and who doesn’t need to visit hospital at all. I should declare an interest as my company, Cinapsis, does exactly this through video calling between the two levels and integration with NHS data systems.
From my experience in the NHS I realised that allowing a GP to instantaneously ask a specialist for advice, while still keeping care in the community, would massively reduce waiting times and take a huge amount of pressure off doctors and nurses. Now, in one NHS Trust, for example, we have reduced A&E hospital visits by 83%, and the time specialist doctors spend on triage by up to 50%.
This is not a cure-all, and there are plenty of other aspects of the NHS that need reform to optimise its processes. But it is a start, and a small change can have a big impact at a time when we need to provide NHS staff with every bit of support they can have. Let’s liberate doctors and nurses from the quagmire of analogue bureaucracy to let them crack on with solving the issues that matter. Remember, every minute of doctors’ time we save directly translates to better patient outcomes.
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