Written evidence submitted by The Medical Technology Group
The Medical Technology Group (MTG) is a UK coalition of patient groups, research charities and medical device companies working together to improve access to medical technologies for patients.
The Group benefits from a wealth of experience in working with the NHS and associated bodies to promote access to medical technologies for patients. The Group wishes to ensure that the patient voice is heard in the conversation about the NHS backlog and waiting times worsened by COVID-19, and that positive changes seen during the pandemic are taken forward to ensure benefit to patients in the future.
The Medical Technology Group has produced a number of reports that will form the basis of this submission, including Ration Watch - Tackling Regional Variation in Healthcare: Inequalities, Innovation and Integration and the NHS Backlog Briefing[i].
These reports look in detail at the issues of tackling the elective backlog, particularly through the use of medical technology and innovation, whilst ensuring that the patient, and their experience, remained central to all decision-making processes. The report was carried out when Clinical Commissioning Groups (CCGs) were still in place.
The NHS Backlog Briefing highlights a number of challenges caused by the elective backlog, including the impact of a long wait on patient outcomes; with patients often requiring more intensive treatment, experiencing a slower recovery and living with their conditions; and it’s wider societal, financial and economical impacts for longer.
Medical technology has the potential to streamline pathways; reduce pressures on the workforce; reduce pressures on acute settings; and help to support the prevention agenda.
It is essential that both medical technology and patient experience play a central role in the tackling of the elective care backlog. This response will use some examples of best practice to demonstrate that this is the case.
The pandemic has put a huge burden on the NHS, which was already facing significant challenges prior to the outbreak of COVID-19. These challenges are exacerbated by existing underlying issues in areas, including socio-economic challenges, funding pressures, and an increase in demand from an aging population, often engaging the system with multiple co-morbidities.
The NHS will require every tool available to tackle these challenges, including medical technologies, collaboration and new models of working.
Tackling the backlog will require collaboration, and working across natural boundaries and borders to tackle common challenges. This has been demonstrated most acutely through provider collaboratives, where providers have worked together to tackle waiting lists and common challenges. This is a key tool in the fight against the backlog, and one which may be used increasingly as the Integrated Care System (ICS) embeds, and collaboration across areas is promoted.
The inquiry is looking at the:
NHS England’s Delivery plan for tackling the COVID-19 backlog of elective care had four key areas of delivery:
The Adoption and Uptake of Medical Technology
The Medical Technology Group supports the general design of the plan for tackling the COVID-19 backlog of elective care. However, the plan is not explicit enough on its calls for further adoption and uptake of medical technologies to support the efforts to tackle the backlog.
The benefits of technology include:
As noted in the MTG’s NHS Backlog Briefing report, there are numerous examples of where medical technology and innovation have helped to enhance patient experience, provide a better standard of care, and help support the NHS to tackle the backlog.
For example, one way to help ease the burden on endoscopy services is through the introduction of a transnasal endoscopy service, an alternative to conventional oral gastroscopy. Transnasal endoscopy utilises a super slim scope which can be inserted through the nose, avoiding the gag reflex and making the procedure more comfortable for patients.
A Transnasal procedure requires minimal, or in the majority of cases, no sedation, enabling quicker patient recovery and reducing personal inconvenience. This also leads to an increase in throughput, allowing the hospital to carry out more gastroscopies per session, reducing cancer waiting lists and freeing-up procedural time and resource for more complex procedures.
Transnasal service can be delivered in an outpatient setting; this presents an opportunity to free-up vital clinical space within the dedicated endoscopy unit and involves no significant infrastructural changes. A further benefit associated with outpatient Transnasal services is the potential to upskill and champion the role of Nurse Endoscopists.
Sharing Best Practice
The elective backlog plan is also unclear on its plan to take into consideration the variation in capability, capacity and coordination of hospitals, Trusts and ICSs across the country, and the challenges that this variation causes in the overall effort to tackle the backlog.
The MTG’s Ration Watch report found significant variation in a range of treatment areas across the country, including within specific regions, and in some instances, between treatment areas within individual CCGs.
It is vital that any effort to tackle the backlog understands the challenges that individual hospitals, Trusts and ICSs face when tackling their own backlogs, and utilises best practice to ‘level up’ that care across the country.
The Ration Watch report found that for General Surgery services, there was a noted variation, with a clear set of regions coming out on top and bottom.
When analysing NHS England’s Referral to Treatment Time (RTT) data, the North West and North East come out as some of the strongest performing regions nationally. Using the same data, London, the South West and Midlands performed poorly, delivering fewer completed pathways during the time analysed.
Although there was a clear local variation, there were some CCGs consistently amongst the top 10 performers, for example, Tameside and Glossop, Sunderland and North East Lincolnshire. The performance of some CCGs varied significantly through the 9 month period examined, with Greater Preston CCG moving from 106th in the rankings, to 20th.
Unless these regional variations are tackled appropriately, and these ICSs supported to deliver care at the standard of the best Trusts within their area, and to the same standard as the best-performing Trusts across the country, unequal access to treatment will be exacerbated, patients will have unequal care, and there will be areas for which tackling the backlog can only be an aspiration.
When looking at how the delivery plan is being implemented, including assessing early progress made in the recovery of services, it is clear that the regional and local variation noted above continues.
The MTG also notes that patients should be involved in the design of local recovery plans; in the planning for the implementation for the plans; and in measuring the output of the plans. This has been addressed somewhat in ensuring the patients are given more information about their care, including through an enhanced NHS App, as well as greater freedom of choice over their care, including ‘establishing a national network for people waiting a long time’.
Patients should also be given equal access to medical technology to support their care. The plan for tackling the backlog includes commitments around using digital technology and data systems to free up capacity. However, in too many instances, innovation and proven medical technology is not adopted and rolled out in all parts of the country, meaning that too many patients are given unequal access to care compared to peers across the UK.
The Ration Watch report analysed RTT data to show the inequalities in accessing treatment across the country.
The findings of the data show:
The trends which are seen in the completed pathways for each individual disease area are also seen in the overall total completed pathways (total waiting lists) figures. These show a significant regional variation between the best and worst performing CCGs.
Regionally, the South West, South East and North East are the best performing on a consistent basis, with the East, the Midlands and London performing worst consistently through the time period
There were also instances of variation within CCGs, with Surrey Heartlands CCG moving from around 30th in the rankings of CCGs to 11th, markedly improving their performances and outcomes for patients in that time.
Looking to the backlog of care, there needs to be widespread effort to achieve consistency across performance. From July 2021 to March 2022, few CCGs performed consistently well across all four treatment areas examined. NHS England must look at those that did, and disseminate this best practice nationally, whether through changes to individual treatments or structural pathways.
In some areas there was progress in tackling the backlog – for example, the average completed pathway for the 10 best performing CCG across the period rose from 1.02/1000 to 1.25/1000: the biggest increase in the four disease areas analysed. However, this increase was not replicated across all disease areas, or across the country, showing the challenges that exist in making inroads in tackling the backlog effectively.
Shared Referral Pathway
Developing One NHS in Dorset is a collaboration between Dorset County Hospital NHS Foundation Trust, Poole Hospital NHS Foundation Trust and The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust. The hospitals are working in partnership to make the most of local NHS resources, now and for the future.
Developing One NHS in Dorset is one of 50 vanguards across the country which were selected to take a lead on the development of ‘new care models’. These will act as blueprints for the NHS moving forward, and as inspiration to the rest of the health and care system. Dorset CCG has established 10 workstreams looking at different patient and support services: stroke, ophthalmology, women’s health, paediatrics, cardiology, non-surgical cancer, pathology, radiology, health informatics and business support services. For Women’s Health, gynaecology staff from the three acute trusts are working together to shape the future of their services.
They are working towards the alignment of gynaecology services across Dorset by focusing on the patient journey. They have agreed a vision statement that represents what they are trying to achieve ‘To provide a single gynaecology service for the women of Dorset, delivering patient-centred, seamless, equitable care.’ Staff will now become part of small working parties for each patient pathway, to work through the changes in detail, standardising services across Dorset.
To ensure that the NHS successfully tackles the backlog of elective care, the Medical Technology Group recommends that the Government supports the:
For more information on the Medical Technology Group, or the above response, please contact the Secretariat via firstname.lastname@example.org
[i] Medical Technology Group., 2022. Tacking Regional Variation in Healthcare: Inequalities, Innovation and Integration. MTG.