The mystery of the capital’s ‘high-volume’ treatment centres

Increasing numbers of 52-week waiters

Next Thursday we’ll see more waiting list data released.

What is contained in it is probably why Sir David Sloman’s office has taken nearly a month to not answer this question: Your letter to system leaders said you would “eliminate” 52-week waits, by when?

The regional director’s office could not answer, nor could it reveal which hospitals were going to be the high-volume centre to burn through the lists in the six major specialities.

There are a couple of likely reasons for their not being able to say when the long waiters would be eliminated.

NHSI/E’s phase three letter set “mad” targets that don’t feel very real to many on the ground. I/E central will know this and have their own reasons for setting stretching-to-the-point-of-snapping targets, but trusts don’t really want to be held to submitting impossible commitments then being chastised for missing them (management teams have been moved on for this kind of thing in less fraught times).

The second reason is that the picture is likely to be scary and also to have an impact on the ongoing three-way negotiation between the NHS, the independent sector - which will be hosting a lot of this work - and the workforce that will actually do it in both places.

There is even less transparency than usual from the regional director’s office and I/E generally when asked anything at all about how effectively private sector facilities are being used, or how much it is costing.

Much more surprising is the fact that Sir David’s office cannot yet name where each of the ICS’s six high-volume centres will be.

The capita’s ICSs have all submitted their final plans to the London NHSE office. The service should still be bathed in the glow of clinical co-operation across organisational lines, the spirit that made such a difference when London faced the worst of the first wave.

So can it really be that the location of these centres have not been agreed in the face of urgent clinical need?

If so, that would suggest organisational and departmental squabbles, which often come down to physically where an individual clinician is going to do their operations, have already trumped the greater good. A bit of a shame if so (of the six specialties that comprise 70 per cent of the list - orthopaedics, ophthalmology, urology, gynaecology, ENT and general surgery – the first two are where NHS provision has historically been, well, affected by the private sector).

The catch-up is being led by Moorfields chief exec David Probert and GIRFT boss Professor Tim Briggs. Hopefully they can make the “’One workforce, one estate’ mindset” more than just an aspiration.

We probably won’t see an actual fall in 52-week waiters until March and April, when it will have been 12 months since the great falling off of referrals.

Even that depends on the service managing to deliver procedures at all as covid outbreaks shut down facilities and take out clinicians forced to isolate because a household member has tested positive. This is already happening in some parts of the country.

If the next wave is very severe we could lose even more ground on cancer.

The three-month decision-to-treat cancer waiters

Although 104-day+ waits were designated a priority for ICSs by Sir Simon Stevens, NHS I/E had always been coy/obstructive about telling anyone how many of these people there were.

The centre releases waiting time data for cancers that have been treated, not for those still waiting – which is what you would want if you were trying to get a sense of the scale of the problem, rather than to, I don’t know, conceal it from a worried public.

Considering that in August nationally, nearly 11,000 people were waiting more than 104 days it would be of concern.

It has come down by about half nationally since then, and London’s cancer long waiters comprise about a quarter of the national total.

The last data that was made available (through a leak, not a sudden outbreak of transparency) showed London had slightly under 100 patients with cancer awaiting treatment in the capital who had waited more than 104 days. Perhaps there are good reasons for this, or some kind of regional issue we should be aware of, but in the face of the usual opacity, we don’t know.

The capital’s record on transparency on cancer services is already patchy.

Endoscopy and allocations

On the brighter side, heroic efforts may have seen London’s NHS get back to business as usual activity levels on endoscopy.

This had been a disaster (at King’s it had been a disaster for years) but now the total waiting list at least looks stable, if still bigger than before.

There has been a fair amount of money put into this effort. How much and where? The regional director’s office are content for you to wait, probably until the NAO get round to looking at it.

But money overall is another issue where the unity of the ICSs looks to be under strain.

With budget allocations handed out (and some concern over their size) there are in some quarters big intra-ICS rumbles over who gets what from a block contract budget, places with big deficits pitched against those without. It’s a tough ask of ICS leadership at a time when they’re also asking institutions to consider themselves as one institution, and to commit to sometimes fanciful activity targets.