The NHS is ailing – but money isn’t the only cure

Dr Owain Rhys Hughes, founder and CEO at Cinapsis

It’s been a record-breaking spring in the Welsh NHS – but for all the wrong reasons. Headlines have been dominated by spiralling wait times at A&E and ever-lengthening ambulance response times, whilst the total number of patients awaiting hospital treatment has hit record levels for the 21st month in a row, with totals now approaching the 700,000 mark.

The government has just promised that no one will wait longer than a year for elective treatment by 2025, despite the fact – as things stand – patients have been waiting more than a year for 168,521 procedures in Wales. And, as pent-up demand for elective procedures and mental health support hits service providers who are still reeling from the impact of Covid-19, all signs point to a summer of discontent ahead for staff and patients.

Amongst my fellow doctors, as well as amongst health sector leaders and politicians, there’s no disagreement about the urgent need to find solutions to this crisis. But it’s the conversation about what those solutions should look like that matters right now.

Broken

Announcing cash injections and budgetary increases for the NHS tends to be popular and praised. But as in most domains of life, cheques are no magic cure. I’m not denying that more money is always needed, or that it does help increase system capacity. But I believe that unless cash is accompanied by ambitious attempts to tackle the roots of the crisis, staff will continue to burn out and the NHS will always struggle to sustainably keep pace with demand.

Ask anyone with first-hand experience of working in the NHS and they’ll confirm that many of the fundamental systems are broken, no longer securing optimal outcomes for anyone. Over the last decade, poor prioritisation at a government level and a lack of concerted effort to push through reforms have resulted in communication blockages, siloed working patterns, disjointed services and tangles of red tape.

This is immensely frustrating for clinicians, who want to spend their time caring for the patients who need them most, not struggling with time-consuming data entry, getting lost in email chains or reassuring frustrated waiting-list dwellers. It follows that, in order to free up clinical capacity and reduce burnout, we need to design and build systems that talk to each other, that automate laborious tasks and that guide clinicians to the appropriate care pathway.

Imagination

For example: currently, when a GP sees a patient who needs further tests, specialist advice or care, they’ll often refer them straight to A&E or a specialist clinic. But in many cases, this is far from the best course of action: the patient might not need to attend hospital at all. When blocked communication channels lock up knowledge and prevent advice and guidance flowing to where it is most needed, waiting times and pressures are compounded.

Change is possible. New digital tools have the power to unblock the channels of communication, allowing GPs to obtain advice and guidance from colleagues and use this knowledge to make shared referral decisions. This is a powerful way of ensuring that patients are sent along the best care pathways – and with an estimated 500,000 referrals that were not made during the pandemic now expected to hit secondary care, there’s not time to waste.

Expanding the systems and tech that streamline this shared decision making would mean that suspected cancer patients – hundreds of whom are currently experiencing dangerous delays – could be fast-tracked to secure a diagnosis and have the start of their treatment accelerated. It would help turn unplanned A&E arrivals into planned clinic visits. It would unlock the power of collaboration between previously isolated NHS services and colleagues.

So yes, we need money for these changes. But most importantly, we need carefully thought through spending plans and long term investment into tech that clinicians actually want to use and that delivers proven benefits.

And yes, now is a moment of crisis in the NHS. But it’s also a moment for imagination and hope, for seizing the best of the best new solutions, and for commitments and action on change. I, for one, see light at the end of the tunnel.