Daily Insight: The risks of doing nothing

The ‘do nothing’ scenario

The recent downgrading of the elective care target by NHS England led to lots of warnings about a growing waiting list and backlog of patients breaching the national 18 week standard.

And a document obtained by HSJ provides an official estimate of the deterioration, assuming no action is taken.

It sets out a “do nothing” scenario in which performance against elective care targets deteriorates significantly over the next two years.

It suggests the backlog of patients waiting more than 18 weeks would grow from around 370,000 in February 2017 to almost 800,000 by March 2019, while the overall waiting list would grow from around 4 million to almost 5.5 million.

The story was picked up on the front page of The Times, and in most national newspapers.

NHS England and NHS Improvement, of course, argue that “lots” is being done to prevent this, and the document implies that a national programme to improve the productivity of surgical teams will help improve on the ”do nothing”.

But it’s unclear how much impact this programme will have, and the Royal College of Surgeons reckons that without “clear proposals” being put forward to protect capacity and tackle waiting times, the NHS is effectively in the “do nothing” scenario.

The RCS says this will be “devastating for patients”, and not just for those needing hip and knee replacements, but also for more serious heart and brain operations where, in some circumstances, it says serious disability or even death may result from long waits.

NHS Providers have also expressed concerns about the impact on trust finances, while waiting list expert Rob Findlay argues that letting the backlog swell is a false economy, akin to borrowing money from a loan shark.

Budget raiders

The Department of Health has confirmed that NHS investment funds will continue to be raided for the next three years to prop up day to day revenue budgets.

In a letter to the Commons health committee last month, minister Philip Dunne said the DH is planning to cease transferring money from capital budgets by the end of 2019-20, with the size of the transfers being reduced each year.

In December, HSJ reported figures used by national NHS leaders in a presentation document, which said £1bn would be transferred this year, followed by £500m in 2018-19 and £250m in 2019-20. However, the DH would not confirm these figures at the time.

The capital budget has been repeatedly raided in recent years to balance growing revenue deficits in the NHS trust sector, with £1.2bn transferred in 2016-17 and £950m the previous year.

The shortage of capital funding means NHS Improvement has been looking to encourage forms of “off balance sheet” private investment, and therefore not score against the government spending limits.

In a note attached to the DH annual accounts in July, the head of the National Audit Office raised concerns about the transfer in 2015-16, saying this approach was “unsustainable” and would have “significant consequences for both service users and taxpayers”.

NEW Devon’s new directions

The largest CCG in the country has been given fresh legal directions after it dramatically overshot its target deficit for 2016-17.

NHS England has imposed several instructions on Northern, Eastern and Western Devon CCG, which has been in the region’s success regime since 2015, and is still yet to agree its operating plan for 2017-18 with regulators. The deadline for submitting the plan is Friday.

The CCG ended 2016-17 reporting a deficit of £120.5m – a figure which includes “some element” from the wider NEW Devon health economy, a CCG spokeswoman said.