The care backlog and addressing regional disparities

The Elective Care backlog plan must address regional inequalities if it is to be effective, writes Barbara Harpham, chair of the Medical Technology Group

At a time when the Omicron variant threatened to delay it even further, it was a great relief to finally see the government release its plan for how to deal with the elective care backlog. Reading the plans reminded me of the immense strain our health service has been under over the last two years, as well as the ongoing resourcefulness and resilience of its staff. There are currently six million patients waiting for urgent diagnosis and treatment, and we welcome the government's significant funding commitment and plans to get elective care services back to full capacity. Making the plan come to fruition is an enormous undertaking and the MTG fully supports these efforts.      

A recovery driven by technology
The plans made for promising reading from a medical technology perspective. We are pleased to see that the government has acted on the recommendations from our 2021 Manifesto, prioritising patient choice and location of treatment alongside further funding for Community Diagnostic Centres. Indeed, much of what the government highlights as best practice in its plan is closely aligned with our long term vision for the health service - the use of data and investment to make more efficient use of resources, the use of technology to treat and diagnose patients at home as well as the uptake of robotics in surgery. These all require initial investments, but as shown in our Keeping Britain Working report, they lead to substantial long term savings with faster recovery rates and better patient outcomes.

Amidst the report release, I’ve heard calls for realism over the government’s targets. Tim Gardner at the Health Foundation rightly describes the challenge as ‘daunting,’ but the funding commitment should not be underestimated. If the Treasury sticks to its promise, we will see £10 billion of extra funds aimed at tackling the backlog in the next three years. This is alongside the £250 million announced at the end of last year to upgrade diagnostic technology across the health service. If the money is used wisely, there is every chance the government can hit its targets.

Ending the NHS postcode lottery
Key to doing this will be ensuring funds are evenly distributed across our health service. We’ve been campaigning to point out the stark regional inequalities that exist in the NHS when it comes to accessing the latest treatments and medical technology. Our ongoing RationWatch campaign continues to highlight variations in local commissioning, meaning too often postcode - rather than patient needs - dictate the course and outcomes of treatment. Last October, we found this in the numbers when analysing CCG/ICB performance across England. Of the ten best performing Clinical Commissioning Groups, six were in the North, while seven of the ten worst performing were located in the Midlands and the South. This suggests that patients in the north of England are more likely to receive access to better treatments than those in the south.

As the recovery plan sets off, the causes of this regional inequality need to be addressed. The main reason is the way the health surface is structured. Devolution of decision-making to local NHS organisations means that the final decisions on which treatments are offered locally and under what circumstances is governed by individual Clinical Commissioning Groups. In the government plan we read a number of promising case studies for effective diagnosis and treatment using the latest technology, and it would make sense for patients to have equal access to this best practice regardless of where they live. We frequently hear from patients unable to access treatments provided to a member of a family for the same problem in a different part of the country - often due to arbitrary restrictions such as pain and weight thresholds imposed by these CCGs.

We frequently meet different stakeholders in industry, academia and the NHS to ensure better pathways for patient access to treatments. But stakeholder support is not sufficient. Financial and political support needs to be put in place to ensure a more robust system of accountability for local commissioning. As the health service moves to be restructured around regional Integrated Care Systems (ICSs) we will be eager to see how the Integrated Care Boards (ICBs) which manage them will use their new local commissioning powers. To ensure they prioritise the patient voice, we would like to see a national body able to intervene when local commissioning practises are deemed unfair, as well as a clearer process for patient appeal. With this influx of funding, now more than ever, we need a system of checks on CCG and future ICB decision-making to ensure better outcomes for patients across the NHS.

A more collaborative workforce plan
Alongside a greater accountability for local commissioning practises, there needs to be a more comprehensive workforce plan. The elective care recovery plan largely reiterates the promises made in the July 2020 NHS People Plan. We appreciate there is no magic wand to solve the ongoing problem of recruitment to our health service, but planning can go beyond increased funding and recruitment targets. We support the ABHI's call for a joint NHS/NHS Supply Chain and industry taskforce to be established in order to review and address workforce development, processes and systems as the NHS restarts elective procedures. Moreover, in its plans the government recognises the need to make better use of staff time through investment in digital pathology, imaging, diagnostics and artificial intelligence.

With funding now in place to do this, we want to see the government and NHS England more open to forming new partnerships with academia and industry to transform the current capacity of the NHS, especially to ensure that 1) patients are treated as rapidly as possible; 2) treatment is tailored to best meet the patient’s clinical needs. This requires greater availability of robust diagnostics and innovative treatment options. The Medical Technology Group exists to advise on the formation of such partnerships, as well as the uptake of specific technology, and we look forward to further working with NHS England in this regard.

In the coming year we see a real opportunity to address the regional inequalities  across our health service made worse by the pandemic. Funding has always been the barrier to resolving the postcode lottery, and by ensuring it is spread evenly and fairly across the health system through better CCG/ICB accountability and a more collaborative workforce plan, we can go a long way to ensuring better patient outcomes across the country. With this renewed support, we are now looking forward to working with the Government and NHS England to level up access to life changing and life enhancing treatments that deliver long term benefits to patients, society and the economy.

The Medical Technology Group is a not for profit organisation working to improve patient access to effective medical technologies.