London Eye: ‘Mad’

“Mad.”

The one-word text London Eye got from a senior manager in the capital when we enquired as to what they made of the phase three guidance.

Elaborating, they specified the outpatients requirement, to carry out 100 per cent of last year’s activity from September, after hitting 90 per cent in August.

The P3 guidance issued at the end of last week was high on the proportion-of-last-year’s-workload-it-expected-the-system-to-do, low on ways to do this.

Another senior figure said: “We have spent years trying to reduce outpatients and now we are incentivising people to see more (although they can be virtual)”.

Maybe doing a lot of outpatients via the Zoom Presumption (as specified by Matt Hancock, and which I’m sure has been thoroughly risk-assessed to prevent another WannaCry, but this time when the service is even more dependent on creaky IT systems) will make a dent in the elective waiting list.

But the limiting factors loom large.

Managers have been trying to get their staff to take leave they have built up over the past five months, and ahead of winter.

Significant as the covid-slowdown from doffing and donning, blue and green separation, pre-op quarantining or not is, the main barrier remains staffing, particularly, for surgery, for anaesthetists (44 per cent of whom reckon their hospitals can’t do covid and non-covid at the same time if there’s a second spike).

The prospect of a second surge has hardly receded in recent days, with multiple outbreaks since workplaces, pubs, and much else reopened.

So why the big push on outpatients?

The point has been made elsewhere that unglamorous as outpatients appointments are, as ripe for the chop from the axe of technology as they may appear, outpatient appointments are often where a cancer gets diagnosed. And cancer was the first priority mentioned in NHS England’s recovery wishlist, sorry, action plan.

The government has pledged to return cancer referral volumes and time-to-treatment to pre-pandemic levels.

London needs to do 15,000 endoscopies a month to catch up with the backlog and while the P3 document mentions this it doesn’t say how apart from “releasing endoscopy staff from other duties”.

Behind the whole document lurk the unanswered questions about unlimited, centrally funded independent sector access, and how long it’s going to last.

On cancer treatment, the NHSE document said patients who had waited more than 104 days had to be prioritised. London’s hospitals don’t come out too badly from this measure. The May data (the latest) suggests that of the people who were over 104 days, or at risk of going over 104 days, most were now outside the capital.

Of the 20 trusts with the highest volumes by this measure, only two — Barking, Havering and Redbirdge and the Royal Free — were in London.

The former also had one of the worst 62-day wait performances  – 40.1 per cent against a national average of 70 and target of 85 per cent.

Exerting control

Royal Brompton and Harefield FT, the heart and lung specialist, played a leading role in the capital’s response to the first covid surge.

As one of the two centres where cardiac work was carried out peak-outbreak, and one of just five places offering extracorporeal membrane oxygenation (better known as ECMO), the trust was a centrepiece. By this time next year though it will likely no longer exist as a separate entity, a merger with Guy’s and St Thomas’ FT expected early next year.

Probably no trust embodied the freedoms granted to FTs better than RBHT — it took NHS England to judicial review and won over previous attempts to move some of its work to other centres, and has pledged to spend the money it will make from selling its Chelsea site for a rebuild south of the river.

It’s fair to say the north west London clinical, academic and NHS management worlds have been sore about this international specialist becoming part of the King’s College orbit, in the south east, instead.

Perhaps these tensions lay behind a note in minutes in RBHT’s most recent board papers: ”It was noted that there were continued challenges from the NWL [integrated care system], as they appeared to be seeking to exert a significant amount of control over its members. GSTT was not experiencing this in their ICS.”

Whatever form this exertion took it seems it was too late. RBHT will join up with its southern neighbour, making the UK’s biggest health provider, which will presumably need a new name (something that could also address the “part-founded by a slave trader” problem).