Trust ‘fighting losing battle’ over elective waits, CEO admits

Joe Harrison told HSJ Milton Keynes University Hospital Foundation Trust was “fighting a losing battle” because both cancer and urgent referrals were increasing at an “unprecedented rate”.

He said: “We don’t know why we are seeing increases at this scale. We are getting 50 more referrals a day for cancer than we were getting pre-pandemic. It is a mind-blowing increase in a short period.”

MKUH’s performance against the 65-week target has sharply declined over the past year, with the provider falling from the middle of the table of trusts ranked on long waiters to being in the worst three. 

The trust also had the highest proportion of 18-week wait breaches for any acute provider in January, meeting the target for just 34.5 per cent of patients.

However, Mr Harrison said the waiting times deterioration was happening, despite MKUH being among the best performers on recovering elective activity levels, as was on course to deliver 125 per cent of its pre-covid volumes in 2023-24. 

He added: “We are doing all this extra work but we are not yet getting the traction on reducing routine waiting times because we have had to focus on urgent and emergencies”.

The trust said its referrals for urgent suspected cancer increased by 55 per cent between 2019 and 2023. Nationally, referrals increased by just over a quarter.

MKUH said all urgent referrals – including but not limited to cancer – increased by 80 per cent between April 2019 and December last year. 

There is no comparable public national statistic, but those available suggest a higher-than-average increase for the Bedfordshire, Luton and Milton Keynes system. 

Referrals in the system increased by 75 per cent between late 2019-20 and late 2023-24, compared to 40 per cent nationally.

Mr Harrison said the trust did not know exactly why it was seeing such a high level of increases, but it was not thought to be linked to delayed covid presentations, as it is “slightly too late”.

Milton Keynes is one of England’s fastest growing cities, with Mr Harrison saying this rising population is likely a factor, as well as a popular new cancer centre.

He said: “We are concerned it might be the new norm in terms of activity volumes… If we see this demand for urgent and cancer performance continuing, we will have to change the way we structure our elective care. It is as simple as that.”

The trust is looking to increase capacity, for example with an additional theatre on site, and encourage teams to continue to improve efficiency to drive improvements.