Andrew Haldenby is co-founder of Aiming for Health Success, a new health research body
Source of information: National Joint Registry
Sajid Javid is about to announce the most important health announcement of this Parliament, and likely the most important of his tenure as Health Secretary.
He has promised the plan to eliminate the hospital backlog, and spend the extra money raised by the health and care levy, by the end of this month.
Some might say that the levy itself was the big moment. Raising £12 billion per year in extra taxation, and breaking a manifesto commitment to do it, was clearly a defining moment in the political history of this Government.
But for the NHS, what matters is not so much the extra money but how it is spent. The Blair Government raised taxes and recovered waiting lists – but left an unnecessarily expensive, hospital-dominated NHS ill equipped for modern needs.
Javid can and must do better. He not only has to regain control of the waiting list but also improve the pattern of NHS services, and their value for money, for the long term. Productivity matters because NHS resources are finite. Better use of money means that more patients can be treated and more illnesses managed or prevented.
The Health Secretary has said that surgical hubs will be a key part of the new plan – i.e. local specialist centres which carry out a higher volume of operations and treatments than normal hospitals.
He is right: hubs are exactly the kind of high-productivity units that the NHS should provide. But the Service will need almost unprecedented levels of imagination and commitment to change if it is to pull them off.
Hubs are the right idea because, in medicine, practice makes perfect: concentrating treatment on a smaller number of sites makes surgeons more practiced and safer. There is no way that any government can increase the number of experienced surgeons over the next five years, so it is vital to use their time more effectively.
Previous governments have much improved stroke care and trauma care by creating hubs for those specialities, and there are many similar international examples from the USA to India. Higher levels of quality also mean higher productivity, partly on account of reduced numbers of readmissions due to medical error.
For the speciality with the best data – joint replacements – the table above shows that the NHS does operate hubs, which treat five or six times as many patients per year as the typical NHS hospital.
These are distinctive, high-quality facilities. The South West London Elective Orthopaedic Centre (SWELOC) is one of the few NHS units in London rated as outstanding by the Care Quality Commission. It carries out a fifth of all joint replacements in London per year. Staff at centres such as the Robert Jones and Agnes Hunt Orthopaedic Hospital have achieved pioneering advances in medical research and technology.
But there are very few hubs – only six across the whole of England and most outside of London. There are none at all in the North East, South Central, East of England, Yorkshire and Humber and the South West (see map above).
More importantly for the Health Secretary, only three of the six have been introduced since the NHS began in 1948. That is a big reminder that genuine innovation in the NHS – i.e. significant improvements in services for many patient – has not been easy.
Given the health and care levy, Javid has a rare opportunity to demand major advances in the quality and productivity of NHS resources. Real surgical hubs should be part of that, with much greater capacity and safety, than typical hospitals. He should also ask NHS leaders to provide full regional coverage, starting with patients in the relatively deprived areas of Yorkshire and the Humber.
The Health Secretary may find opposition from some NHS doctors who would prefer services to stay in their own hospitals, for the sake of convenience, rather than move to the hubs. The evidence of the existing hubs, and the similar units working in trauma and stroke care, shows that he should take that battle on.
Surgical hubs would take up to two years to deliver. In the meantime, there are immediate steps that can be taken to improve productivity, many suggested by orthopaedic consultants themselves such as Nate Macdonald, for example asking patients to wait on a reserve list in case of cancellations. The combination of practical improvements and extra hubs can deliver the extra 30 per cent in activity that Ministers desire.
Javid has set three priorities for his term in office: “Covid”, “recovery” (of the waiting list) and “reform”. This month will show how well the NHS will deliver for him. An excellent plan would include initiatives like hubs which increase the volume and safety of hospital operations. It would explain how the NHS will prevent future backlogs by shifting away from hospital-focused care towards early diagnosis and treatment in more accessible community facilities. It would say that the productivity of the NHS budget matters as much as its size. Over to you, Health Secretary.