The Hidden Challenges Behind Reducing Waiting Lists

Waiting lists are one major area of concern for the NHS. But lists alone don’t tell the whole story of the challenge we face, says Jim Newman.

It’s hardly news to say that waiting lists are extremely high across West Yorkshire right now. As my Yorkshire Knee Clinic colleagues have said recently, the picture may be relatively better here than in some other areas of the country, but don’t let that fool you into thinking we don’t face enormous challenges in reducing waiting lists to pre-pandemic levels. And one of the biggest challenges is that the growing lists are like the tip of the iceberg – the visible peak of a much bigger problem.

Although elective surgery has been coming back online, for example, we still face issues in getting theatres back up to full capacity. In part, that’s a result of ongoing social distancing measures. But it’s also a staffing issue. After a punishingly difficult year, lots of staff have decided it’s time to retire.

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Shifting foundations

An even greater challenge is that when patients are forced to wait longer for their surgery, their condition may change. Those waiting for knee replacements may find the joint stiffens. They may develop other medical complaints that make surgery more difficult.

A lot of the work I’m doing right now is trying to get these patients reassessed. As you can imagine, that’s placing even greater pressure on pre-op assessment teams who would usually carry out one assessment on a patient, and are now doing all the swabs, bloods and medical condition checks again.

For some of our longest-waiting patients, I’m now talking with community-based musculo- skeletal triage and physio teams to see how we might run pre-op rehabilitation sessions to try and ensure the joints are as supple and mobile as they can be before we operate. These are hidden problems in many ways – ones we really haven’t seen for years. But finding a solution is absolutely vital.

That’s because there’s lots of evidence that says if you wait longer you do worse. Intuitively that makes sense, because the longer you wait for your operation, the greater the chance you find that the ‘foundations’ the patient first presented with have shifted.

Avoiding burnout

How are we responding? In my own trust – Mid Yorkshire Hospitals NHS Trust – we’re already working weekends. Evening work is a probability. But we have to be extremely careful to avoid staff burnout.

After the most punishing of years, you might think staff were already at burnout point. It’s certainly not been easy – as we’ve seen, some have made the decision to retire. But there has also been a wonderful ‘bounce’ as staff have returned to their teams, doing things they are really good at with people they know well. That has helped mitigate the bruises of the past year to some degree – but we have to be careful not to push it too far.

So where does that leave you if you are on an NHS waiting list for a knee replacement? I think the important thing to stress is that if your condition has changed since you were last assessed – if you have developed complications or you feel your joint has significantly worsened – you must let the surgeon know. It could have a significant impact on your wait time and the treatment you may require.

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> Knee surgery in Yorkshire – what’s happening right now?