Thousands of 'extra' ops planned to slash Lancashire's Covid backlog

The region was confirmed last month as one of the government’s “accelerator” areas, which will receive a share from a £160m pot designed to enable the NHS to get through a greater volume of pre-planned work across a three-month period.

The healthcare system in Lancashire and South Cumbria has set itself a target of delivering 20 percent more activity by the end of July than it was doing at the equivalent point in 2019.

A meeting of the region’s integrated care system (ICS) board earlier this month heard that, if that, if the target is hit, it would mean over 6,000 additional inpatient day case operations would be undertaken.

Under the plans, almost 8,000 extra diagnostic tests would be carried out, while over 72,000 more people would receive outpatient appointments.

That is against a backdrop of the waiting list at the trust that runs Royal Preston and Chorley and South Ribble Hospital increasing by almost 15,000 patients between February 2020 and April 2021 to stand at almost 49,000 – and the number of people waiting over a year for treatment leaping from none to 7,204 over the same period. A recent meeting of Central Lancashire s clinical commissioning groups heard that Lancashire Teaching Hospitals NHS Foundation Trust (LTH) had reduced the latter figure to around 6,800 by the start of this month.

ICS board members heard that, during May, when the accelerator work got under way, cancellation rates were running at a “very low” three percent – and that there was now a greater confidence amongst patients to come into hospital for treatment than there had been during earlier stages of the pandemic.

Kevin McGee, who will later this year take on the role of chief executive at LTH, said that the step up in work was a “really big ask, but a laudable [one] – and a good ambition in terms of the level of waiting list that we’ve got”.

“We’re looking to extend our capacity through weekend working [and] we’re looking to both insource and outsource activity.” added Mr. McGee, meaning that the additional work could be undertaken directly by NHS trusts or paid for in the private sector.

He also warned that one of the risks to the ambition the region had set itself was any increase in Covid admissions, particularly to critical care, where space is required for people to recover from the most serious pre-planned operations.

The meeting was told that the accelerator project would not skew a commitment to treat patients on the region’s waiting lists in order of need.

“You could hit 120 percent [the accelerator target] by focusing your activity on low-risk, high throughput…[but] our clinical and operational teams have taken a really good, risk-based approach to making sure we continue to treat patients in order of clinical priority – just more quickly, “ explained Aaron Cummins, chief executive of University Hospitals of Morecambe Bay NHS Foundation Trust.

He said that the decision to volunteer to become an accelerator area had been taken in the knowledge that “staff were tired and…looking forward to breaks, but the opportunity to have many thousands more patients treated much more quickly than we could have done without this kind of programme was a significant driver”.

Mr. Cummins added that the initiative would enable the region to show what it could do “with a bit more support and investment”.

Separately, Lancashire and South Cumbria also has access to England’s £1bn elective recovery fund, which sees areas receive extra cash for any additional work they do.

Kevin McGee also revealed that it was a “long-term ambition” for Lancashire and South Cumbria to have a shared waiting list across all of the hospital trusts in the region, so that patients could be sent wherever there was space to treat them.

“That different way of working in terms of trying to match our waiting lists to where the capacity is available…is really important for the future,” said Mr. McGee, who will step down from his current roles as chief executive of both Blackpool Teaching Hospitals NHS Foundation Trust and East Lancashire Hospitals Trust when he takes on the top job at Lancashire Teaching Hospitals NHS Foundation Trust (LTH) later in the year.

Moves in that direction have already occurred in one service, with eye patients from East Lancashire being sent to Blackpool, where there was spare capacity for the treatment they needed. While a shared waiting list has not yet been created, hospitals in Lancashire and South Cumbria are now able to view each other’s capacities across different departments.

Mr. McGee also predicted that elective care “hubs” will also ultimately be created in the region, in which pre-planned surgery can take place in what would hopefully remain Covid-free sites.

However, Graham Burgess, chair of Blackburn with Darwen Clinical Commissioning Group (CCG), warned of the practical challenges for some patients if they were to be treated further from home in other parts of the sprawling Lancashire and South Cumbria patch.

He warned that plans could pose a problem for people living in areas with “very low car ownership and high deprivation”.

“I know it’s a difficult issue, but I think [it is something] we need to think of as we move, quite correctly, towards system-wide working,” Mr. Burgess added.

Mr. McGee said that it was an issue that the NHS in the region was “acutely aware of” given the need to avoid doing anything to worsen health inequalities.

“This is the very start of this process…and we have only done it very slowly because of the issues in terms of access and transportation. We are engaged in working with [the North West Regional Ambulance Service about] what this would mean in terms of additional transport for patient[s].

“I suspect that the movement of lists or patients…will only be part of the solution. We’re still going to have to have local services…that can be accessed in a very timely and easy manner in terms of local circumstances,” Mr. McGee added.

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CENTRAL LANCASHIRE WAITING LISTS (by CCG area)

Greater Preston

16.321 - patients on waiting list in Feb 2020, with 15.2 percent waiting more than 18 weeks

21,567 - patients on waiting list in Apr 2021, with 31.4 percent waiting more than 18 weeks

Chorley and South Ribble

14,681 - patients on waiting list in Feb 2020, with 14.7 percent waiting more than 18 weeks

17,946 - patients on waiting list in April 2021, with 33.6 percent waiting more than 18 weeks

Source: NHS Statistics

LANCASHIRE’S HOSPITAL WAITING LISTS PRE AND POST-PANDEMIC

April 2021

Blackpool Teaching Hospitals NHS Foundation Trust

Total list – 18,830

Proportion waiting over 18 weeks – 30.2 percent

Total waiting over 52 weeks – 1,471

East Lancashire Hospitals NHS Trust

Total list – 30,894

Proportion waiting over 18 weeks – not reported in NHS statistics

Total waiting over 52 weeks – 1,215

Lancashire Teaching Hospitals NHS Foundation Trust

Total list – 48,968

Proportion waiting over 18 weeks – 44.5 percent

Total waiting over 52 weeks – 7,204

University Hospitals of Morecambe Bay NHS Foundation Trust

Total list – 24,542

Proportion waiting over 18 weeks – 36.4 percent

Total waiting over 52 weeks – 2,022

February 2020

Blackpool Teaching Hospitals NHS Foundation Trust

Total list – 16,958

Proportion waiting over 18 weeks – 19.3 percent

Total waiting over 52 weeks – 1

East Lancashire Hospitals NHS Trust

Total list – 31,640

Proportion waiting over 18 weeks – not reported in NHS statistics

Total waiting over 52 weeks – 0

Lancashire Teaching Hospitals NHS Foundation Trust

Total list – 33,997

Proportion waiting over 18 weeks – 24.3 percent

Total waiting over 52 weeks – 0

University Hospitals of Morecambe Bay NHS Foundation Trust

Total list – 20,243

Proportion waiting over 18 weeks – 18.4 percent

Total waiting over 52 weeks – 1

Source: NHS Statistics