ICSs given £160m to ‘accelerate’ electives fail to hit pre-covid activity

NHS England selected 12 integrated care systems earlier this year to be part of an “accelerator programme” to help ramp up planned procedures, after activity plummeted during the pandemic.

Systems within the programme have told HSJ they were initially asked to commit to delivering 120 per cent of their pre-covid activity levels from July 2021 onwards (ie a fifth more), although the precise expectations attached to the funding have never been revealed, and are understood to have varied across the different ICSs.

Several sources within the systems confirmed they had struggled even to return to pre-pandemic levels, however, and this is supported by HSJ analysis of activity data published by NHS Digital.

Analysis of the data for the three-month period to September shows all 12 systems in receipt of the extra funding delivered fewer inpatient and daycase procedures than they did in the same period in 2019.

Performance ranged from 97 per cent in Nottingham and Nottinghamshire, to 86 per cent in Lancashire and South Cumbria.

Humber, Coast and Vale, which was not in the programme, was the only system to deliver more than its pre-pandemic activity.

Back in the spring, national elective procedure activity stood at around 85 per cent of pre-covid levels nationally, and this increased to around 96 per cent in June.

At this point it was hoped activity levels would continue rising over the summer, with the “accelerator” areas given funding to go even further.

However, performance has been hampered by a surge in covid patients. This began at the end of June and has seen the proportion of acute beds occupied by covid-positive patients hover around 4 per cent ever since, also putting pressure on critical care.

This has been coupled with high staff absence rates, the ongoing need for infection control measures, difficulties in discharging patients, and sustained emergency pressures.

The accelerator areas did perform marginally better than others over the three-month period, at an average of almost 90 per cent of pre-covid procedures, compared to the national average of around 87 per cent. On outpatient appointments, the accelerators delivered 96 per cent, against the national average of 95 per cent.

Elective treatment activity from July to September

Rob Findlay, an independent waiting list expert, said: “The data shows how difficult it is to increase activity in the current circumstances, and even in the accelerator sites activity has remained well below the high and sustained levels that will be needed to recover waiting times by the end of the decade.”

Systems leaders within the accelerator sites stressed the difficulties that rising covid rates had presented over the summer. They also said some of the investments they had made were aimed at delivering improvements over a longer term.

Barry Mulholland, a partner at MBI Healthcare Technologies, said: “I think this tells us two things. Firstly, despite central investment, particularly relating to accelerator programmes, trust’s elective activity remains hampered by their estate and workforce.

“Throwing more money at the issue will only get you so far. At present, where it gets us is not even back to pre-pandemic levels for the majority of ICS footprints. Secondly, with that in mind, the lead-in-times for solving estate and workforce issues will be longer than anticipated. The direct consequence of that is that the waiting list will continue to grow and patients will continue to wait.”

NHS Providers director of policy and strategy Miriam Deakin, said: “Trust leaders are only too well aware of the impact of delayed treatment for patients and carers and there has been progress in the work to recover services and address the care backlog.

“However, everyone would like to see this move faster… trusts are exploring every avenue to make headway and in the most recent published figures (for September) inpatient elective activity increased by nearly 9 per cent compared with the previous month.”

NHS England said in a statement: “While the combination of urgent and emergency pressures, continued covid-19 cases and workforce pressures has obviously had a knock on effect on elective activity over this period, accelerator sites are delivering higher levels of elective activity in comparison to non-accelerator sites.”

Systems which had higher covid occupancy over the three-month period performed slightly less well in terms of their elective activity. But several ICSs, including Humber. Coast and Vale, delivered relatively high activity levels despite having relatively high covid pressures.