Daily Insight: A time to worry

A huge rise in GP referrals being deferred because no appointment slots are available has sparked safety concerns.

Campaigners have warned of patients “deteriorating” on waiting lists and a “postcode lottery” of care emerging for some conditions, and the Royal College of General Practitioners told HSJ there was a risk of patients “simply disappearing” from lists if “appointment slot issues” were not properly managed.

It comes after HSJ revealed last month that 1,800 patients were automatically taken off Barking, Havering and Redbridge University Hospitals Trust’s elective waiting list before being seen, as a result of a “computer error”. The patients had reportedly been referred just before and during the pandemic.

Charity Patient Safety Learning is calling for NHS England to urgently investigate the issue and quantify the scale of the problem if capacity problems resulting in avoidable harm to patients are to be prevented.

HSJ’s analysis of official data shows ASIs were up by 52 per cent nationally in March 2022, compared to February 2020. NHS Digital data also revealed a wide variation across different health systems and trusts.

The Midlands and South West appeared to have a particularly high percentage of increases in ASIs since before the pandemic.

While there is no rule of what represents a safe ratio, the higher the ratio of ASIs, the greater risk that is needed to be managed.

Key target under threat

July marks the deadline for a major target of the NHS’s elective recovery plan, when all two-year waits for treatment are due to be eliminated.

NHS England chiefs have been quietly optimistic that this target will be achieved, but one struggling integrated care system might throw a spanner in the works.

Devon ICS, which currently has 1,500 two-year patients on its waiting list, is set to miss the target by 860 patients unless more elective capacity can be found outside the county.

This is an ICS so strapped for capacity that it has offered patients care 200 miles away in London, despite being given two trump cards in the last year: Extra funds through the elective accelerator programme and the retention of the Nightingale Hospital.

Why, then, is Devon struggling so much?

The ICS says the impact of the pandemic, and urgent and emergency care pressures, are the main underlying causes of the gap. However, those problems are affecting every ICS.

Other causes are likely to be complex and nigh-on impossible to fix overnight. The ICS has escalated the issue to NHSE, which needs to act fast if this problem is to be solved in time.