Nothing routine about routine operations

Bernard Ross discusses how MedTech is uniquely placed to support healthcare systems by offering faster and more cost-effective solutions to recovery

The BBC recently reported that, as of the end of November 2021, more than six million people were waiting for routine operations in the UK. This was the first time this figure had been hit in the history of the NHS and demonstrated the scale of the backlog in routine operations caused by the Covid-19 health crisis and its knock-on effect on the wellbeing of the nation.

This is not an issue unique to the UK. Research conducted by the Organisation for Economic Co-operation and Development (OECD) suggests that waiting times for ‘elective’ or non-emergency surgery have increased across the economies surveyed, with median wait times for cataract surgery averaging 92 days. For hip replacement, it was 113 days, and for knee replacement, it was 189 days.

While routine operations might not be emergencies, the impact of these delays on people’s lives and the wider the economy are significant. New approaches to medicine are required to deliver a long term and sustainable solution.

Global pressures mounting
The news that six million people are waiting for routine operations in the UK for the first time is perhaps shocking, yet not surprising. The number – which represents not far short of ten percent of the entire UK population – covered a reporting period before the Omicron variant of Covid-19 threw the NHS under additional pressure over the festive period. The next reported number is likely to be higher still.

Before the pandemic, the UK government aimed to offer those that needed non-urgent surgery a procedure within 18 weeks. In 2018, it was reported that hospitals achieved this around 88 per cent of the time. This demonstrates that, even before Covid-19, many patients were waiting a significant amount of time for surgery.

This is not an issue unique to the UK. The OECD reports waiting times for elective surgery vary wildly. In Poland, patients can wait almost 250 days on average for cataracts surgery, while in Estonia hip replacement patients are waiting on average 282 days. The healthcare crisis is a global phenomenon.

Underlying issues
In 2020-2021, The King’s Fund, an independent charitable organisation working to improve health and care in England, reported that the UK spent £192 billion on health and social care.  

This was some £50 billion more than the previous year and represents approximately 10.2 per cent of the country’s GDP. This is by no means out of sync with other countries. Indeed, it is close to the average figure reported by the OECD. Despite this increase in spending, and the NHS vastly increasing the number of tests and treatments offered in the summer of 2021 in response to the Covid-19 backlog, elective surgery waiting lists continued to rise.  

The reality is that the Covid crisis has brought into sharp focus an issue that has developed over decades. The global population has been growing older and living longer and the proportion of people retired, compared to those in work, has increased exponentially. Across the world, whether countries deploy a national healthcare service or not, the demand for healthcare is growing just as the number of people that are in work and can pay for it is falling.

The pandemic has acted as a perfect storm to accelerate these issues, with overstretched healthcare workers having to focus on the immediate crisis at the cost of the wider well-being of the population. Furthermore, the nature of the virus has led to thousands of healthcare workers having to isolate for periods to avoid this risk of further transmission, leaving less people to carry out both routine and emergency procedures.

Nothing routine about elective surgery
For each of the six million people on a waiting list in the UK, there is nothing routine about their condition. Patients waiting for a cataract operation suffer with sensitivity to light and glare as well as clouded, blurred or dimmed vision. They may struggle to see well at night. This can impact people’s ability to work and therefore support themselves and their family. Those waiting for a hip or ankle replacement can be in constant pain. Many are unable to walk, leading to issues around lack of social contact and independence.
The burden of delay is not limited to the individual. If people are unable to work because of their condition, they may require increased access to benefits systems, adding to the overall national cost of a condition. If their condition means reducing their working hours, they will be paying less taxes. They are likely to need more GP and hospital appointments. Prolonged delays to surgery may lead to other conditions such as obesity through lack of movement or mental health issues caused by loneliness. While a hip replacement operation may cost somewhere between £10,000 to £15,000, it is not unreasonable to estimate the total impact on the economy of such an operation as comfortably double this – and grows as delays increase.

This is not to say that healthcare systems are not doing everything they can to reduce this burden.

Healthcare professionals have a history of challenging the status quo to improve patient outcomes. Surgery techniques have radically changed to deliver better healthcare outcomes and doctors are constantly looking to speed recovery to avoid issues of bed blocking and increase the volume of elective operations.  

New thinking in medical technology
Perhaps the biggest opportunity to address these challenges to healthcare systems’ capacity comes in combining technology with medicine in a bid to generate better patient outcomes.  

The medical technology (MedTech) sector has seen substantial growth in recent years – a trend that is expected to continue. The European medical technology market is estimated to be worth more than £102.5 billion, with Germany, France, and the United Kingdom leading the way in research, development, and implementation of new medical devices.  

Indeed, prior to the pandemic in 2019, the total annual revenue of the global MedTech industry stood at £370.9 billion — representing an increasing share of the overall global healthcare sector. By 2025, the global medical devices industry is expected to reach a valuation of £440.5 billion, growing at an average of 5.4 per cent per year.

This trend has been accelerated by the pandemic. As Covid-19 challenged the traditional healthcare processes it forced healthcare systems to quickly implement new solutions, such as tele-consultations and the increased use of remote monitoring to manage patients. This helped demonstrate the transformative potential of technology to healthcare systems.

MedTech can have a significant impact driving transformation around how care is provided, enabling healthcare professionals to focus on the critical. For example, remote monitoring can provide doctors with alerts that inform them of patients’ vital signs, but healthcare professionals will still need to interpret these.

Empowering recovery
One of the areas with most potential is MedTech devices that empower patients’ faster recovery. Devices that reduce swelling, for example, or heal wounds more quickly, can enable patients to manage an increased part of post operative recovery at home. This has several positive outcomes. For the healthcare system, reducing time spent in hospital recovery reduces bed blocking and can free up extra capacity to perform more operations.  

Faster recovery after surgery also reduces the risk of patient complications. Immobile patients are at a higher risk of blood clots, known as venous thromboembolism (VTE). Around 55 – 60 per cent of all VTE cases occur during or following hospitalisation, resulting in approximately 25,000 deaths in England each year alone.  

Sustained time in hospital can also increase risk of infection. According to the World Health Organisation, healthcare associated infections are the most frequent adverse event in healthcare delivery worldwide. 10 per cent of patients in developing countries and seven per cent in developed countries will acquire at least one healthcare associated infection during their time in hospital. Perhaps most importantly, patients that are using MedTech devices to hasten recovery are playing a significant role in their own well-being.  

Innovating healthcare for improved outcomes
Like many industries, Covid-19 has turbo charged a trend in healthcare that was already manifesting.  Hospital waiting lists for routine operations were growing before the pandemic, but the impact on the healthcare crisis has hastened the need to generate meaningful positive change. If any positive has come from the pandemic it is that change that would ordinarily have taken a decade has been implemented in weeks or months. The challenge now is to create healthcare systems that can address not only current needs, but future ones and effectively manage the backlog of elective surgery. The MedTech industry has a critical part to play in delivering the ingenious solutions that will help healthcare systems manage demand today and tomorrow.

Bernard Ross is CEO of Sky Medical Technology.