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Elective care data insights – what have we learnt so far?

In this summary blog, we explore the main findings from our elective care data insights series thus far - where we look beyond the headline data to try and discover solutions to long-standing problems.
Published on
November 24, 2023

In July this year, we launched our elective care data insights series on LinkedIn and X (formerly Twitter) with the goal of offering in-depth analysis into the latest NHS figures.

Rather than merely looking at the headline findings, we have sought to delve deeper – with the help of our Head of Analytics, Adam Ceney – to understand the data at a granular level, spot trends and provide expert comment on the elective care challenges facing the NHS.

Here, in this quarterly review blog, we explore our main takeaways from the data we have analysed thus far.

A mixed picture for long waiters

In the first two of our monthly data insight series, we focused on two key metrics for NHS trusts – 78 and 52 week waiters.

Promisingly, our findings showed that the number of people waiting over 78 weeks for treatment dropped by 81.9% from 59,846 to 10,820 in the year to April 2023. We also found that, of those waiting 78 weeks or more for treatment, more than 50% were concentrated in just 7 out of 42 ICSs. These ICSs covered the whole country, and couldn’t be grouped together geographically, suggesting the problem was now becoming more localised.

However, as we caveated at the time, the data we were analysing was from April 2023 and didn’t factor in the high level of industrial action since.

The most recent data (up until August 2023) showed that there were 9,000 people waiting more than 18 months for treatment, down again on April 2023 but many would argue still much too high. Industrial action could have slowed the rate at which this figure has decreased, as between April and August there was much less of a fall than in the year to April 2023.

The second key metric, 52-plus week waiters, painted a less welcome picture – on the surface, at least.

The number of individuals waiting 52 weeks-plus for treatment (between May 2022 and May 2023) grew by 18.1% from 310,017 to 366,225, which should surely be of some concern. But this was again concentrated, with over 50% of the total 52-plus incomplete waiters found in just 12 of the 42 ICSs. Moreover, 9 of these 12 had over 10,000 individuals currently waiting 52 weeks-plus for treatment.

This suggested an element of ‘don’t judge a book by its cover’ – as we could see, by digging a little deeper, that the majority of the problem was found in around 25% of ICSs and not nationally representative. This surely begged the question of: what can be done to focus on these ICSs in particular to understand the challenges and support with solutions?

Unfortunately, the latest data shows that the number of people waiting more than a year for treatment was higher in August than in July, at just under 397,000. And significantly higher than when we analysed the data from May. This could, in part, be explained by the impact of the strikes, but we need clearer data on this.

This, of course, suggests there is still a considerable challenge in bringing the number of 52 week waiters down – and that current solutions aren’t really doing the trick.

A struggle to reach the 75% cancer target

In September, we explored the latest NHS England data on cancer waits (up to June 2023), to understand how well the 75% target is being met.

We found a mixed picture, with ‘breast symptomatic, cancer not suspected’ consistently meeting the standard with 87% adherence in the 12 months up to June 2023, and up 2.9% on the year before.

By contrast, the national screening programme was tracking at 64.4% in the 12 months up to June 2023, very similar to the 64.3% in the 12 months to June 2022 – suggesting little improvement on this metric.

Meanwhile, urgent suspected cancer was tracking at 70.1% in the 12 months up to June 2023, slightly down on the 70.8% seen in the year to June 2022. Currently, then, the national screening programme and urgent suspected cancer are not meeting the 75% target, which is concerning.

More promisingly, there had been an increase in those being treated. Since the Covid-19 pandemic receded and people could more easily book in-person appointments again, the numbers being treated had risen across all national screening programmes, with a 44.4% increase in breast cancer screening, a 54.8% increase in suspected gynaecological cancer and a huge 93.3% increase in suspected lower gastrointestinal cancer.

In addition, the number of missing or invalid records being recorded fell significantly in the 12 months to June 2023 (down by 67.6%), when compared with the previous period up to June 2022.

In conclusion, while there were some reasons for optimism, the overall picture was one of the 75% standard not being met anywhere near enough – which can’t be blamed on the post-pandemic recovery, industrial action or other issues. It’s important that this is addressed to ensure people get the very best access to cancer treatment.

“For cancer waits, the general excuse you often hear for underperformance is still Covid recovery and industrial action, but it can’t just be due to this alone,” Adam says. “Maybe the targets are the wrong ones, or, more likely, we just need much more investment and resources to meet these standards more effectively.”

Waiting lists will continue to rise next year

Our analysis of the latest waiting list data suggests that waiting lists will continue to rise in 2024, despite the PM Rishi Sunak making cutting NHS waiting lists one of his five key priorities.

In October, it was revealed that NHS waiting lists had risen to a record high of 7.75m. And, based on our analysis of current trends, this is likely to reach close to 8m by March next year. Our findings fell in line with a prediction by the Health Foundation charity, which claimed that waiting lists could surpass 8m by next summer even if strike action was to end.

While the backlog clearly hasn’t been helped by the extent of the industrial action in the last year, it’s interesting to note that the impact of strikes on waiting lists – a long-term, chronic problem – appears to be minimal.

Our analysis found that higher waiting list numbers will be a problem across all of England’s regions by March 2024, with the exception of the South West.

It is clearer than ever that a multi-pronged, long-term approach to cutting waiting lists – that really gets to the root of the problem, makes better use of data and tackles current deficiencies in waitlist management and tracking – is needed to truly start making a dent in these ever-rising numbers.

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