Three month waiting: can it be done?

Emergencies can lead to operations being cancelled

The government is considering a proposal to cut the maximum operation waiting time to three months - but is it possible?

What is clear, even without a major public consultation exercise, is that people think the major problem in the NHS is waiting.

Some people are waiting up to 18 months for non-urgent operations, and waiting times vary widely depending on where you live.

The NHS Confederation, which represents health service managers, has proposed a radical scheme which might be able to cut those waits.

Some surgeons spend most of the winter twiddling their thumbs

Nigel Edwards, NHS Confederation

But there are many in the profession and outside who think the demands it would place on doctors, nurses and hospital managers might prove too great.

There is no way that the problem could be solved simply by training hundreds more specialists in long-wait areas like ear nose and throat, and orthopaedics.

It takes several years to train up even a qualified doctor into a consultant surgeon.

Inefficient

However, there are certainly inefficiencies in the system which could be tackled, says the confederation's Head of Policy Nigel Edwards.

Key among these is a simple lack of staffed hospital beds.

Their scarcity means that when emergency cases come in, particularly during the winter months when flu is rampant, routine operations have to be cancelled.

The changes would mean different job roles

The main problems involve surgery which requires long periods in hospital, for example hip replacements, after which the patient usually spends nine or more days occupying a hospital bed.

These operations can only be carried out when it is guaranteed a bed will be available.

"Some surgeons spend most of the winter twiddling their thumbs," says Nigel Edwards.

He also believes that many patients who don't actually need surgery immediately, if at all, are being added to the waiting list as a precaution, simply because it will be a minimum of a year before they are seen.

"It's a bit like panic buying," he says. "You do it now because you might need it later."

The confederation's plan involves setting up dedicated centres for non-urgent surgery - these facilities could not be hijacked by emergencies.

These would run round the clock where possible.

Breaking down barriers

British Medical Association (BMA) consultants' committee chairman Dr Peter Hawker points out one potential flaw in this.

Wherever you carry out operations, he says, you need access to other facilities, such as intensive care beds in case something goes wrong, x-rays and other testing departments.

In addition, you need other sorts of doctors, such as geriatricians, to make sure the other health needs of patients are catered for.

"The anxiety one would have is that you are cutting surgery off from the rest of medicine," he says.

The confederation's proposal is also heavily dependent on further breaking down the barriers which separate nurses, doctors and other therapists.

Nurses have, in recent years, been given more and more responsibilities. Now they would be expected to take over many of the traditional responsibilities held by doctors, such as assessing patients and deciding who and who not to refer for surgery.

Doing it better

And, says Nigel Edwards, this is a role they may actually do better than doctors.

Elderly patients may need more than a surgeon

"Nurses are, on the whole, much better at following protocols, or a set formula of how patients should be treated."

However, there is bound to be suspicion and even resistance from doctors who feel that their job is being devalued.

However, Dr Hawker says: "You would be surprised how flexible and innovative my colleagues can be. We have been trying to move forward."

But is there enough money to do all this - build the new facilities, hire the new nurses and train the new doctors, as well as pay for the monitoring bodies making sure GPs are sending the right people for operations?

The confederation thinks so - although it concedes that other health issues, such as the funding of new, expensive drugs, could prove a distraction.

And if the waiting times are cut, experience shows that doctors are even more tempted to send more patients for operations.

There are bound to be extra expenses for the government.

Private slump

If waiting times are cut, this will mean less demand for private operations.

Surgeons previously making money in the private sector would need to be compensated for this drop if they are to be persuaded to change their working practices in the NHS.

The government will find that even the best work of the most skilled analysts will not prepare it to make even subtle changes to a system as massive as the NHS.

Those who have tried it in the past have reported astonishing knock-on effects from some of the most straightforward reforms.

It has huge resources at its disposal - a "once in a lifetime chance", as Alan Milburn put it. But uncharted waters lie ahead.