By: Mike Denham, chairman of the TaxPayers' Alliance
As reported in the Times last month, Guys and St Thomas’ have managed to slash waiting lists for some routine surgical procedures using an innovative system known as ‘high intensity theatre’ (HIT). Could this mean a happy new year for patients and taxpayers alike? As the article notes:
“Under the innovative model, two operating theatres run side by side and as soon as one procedure is finished the next patient is already under anaesthetic and ready to be wheeled in.
Nurses are on standby to sterilise the operating theatre and instead of taking 40 minutes between cases it takes less than two, the only delay is the 30 second it takes for the anti-bacterial cleaning fluid to work.
Kariem El-Boghdadly, the consultant anaesthetist who designed the programme with his colleague Imran Ahmad, compares it to a Formula One pit stop. “They’ve got one person doing the rear right wheel, one person doing the front left wheel. It’s the same thing. The operating theatre is effectively like that.”
They’ve achieved some remarkable results. For example they conducted three months’ worth of breast cancer operations in just five days, and increased their daily throughput of knee replacements from the normal three or four, to as many as 12. Patient safety has apparently not been compromised, despite, for example, cutting the time taken to disinfect theatres between patients to two minutes. The team acknowledge that their HIT system is only suitable for straightforward, routine procedures but such procedures account for the bulk of elective surgery cases. This innovation has allowed the team to report significant inroads into its surgery waiting lists.
On the face of it this is a very encouraging development, and the Guys/St Thomas’ team are to be congratulated on their success. It’s good news for their patients and good news for the efficient running of the hospital.
Unsurprisingly there is considerable interest in whether HIT could be rolled out across the NHS more widely, and shadow health secretary Wes Streeting is reportedly very interested. If rolled out nationwide surely it could play a role in bringing down the NHS’s disastrous 7.8 million total waiting list.
However, although we should welcome any ideas that might bring those lists back down into earth’s orbit, taxpayers should demand a very clear and robust plan for dealing with the costs. Because although the Times article doesn’t mention it, elsewhere it’s reported that these HIT sessions require an average of 50 per cent more staff, at an additional average cost of £8,000 per session (Cutting waiting lists with high intensity theatres, The Clinical Services Journal, 3 October 2023).
Now, the Guys and St Thomas’ team justify that additional cost on the basis that it is more than offset by the additional number of completed procedures. They report that on average, across all their various specialisms, an increase of 168% can be achieved with HIT sessions. In other words, the average increase in output is more than three times the average increase in theatre staff numbers. Further, they say that total tariff income (what the hospital gets from the NHS for each procedure) for each HIT session increases by £10,500 to £30,500, more than covering the additional costs. That sounds pretty attractive – a vast increase in cost efficiency for the hospital, and the prospect of making a profit from tariffs still based on the old inefficient way of doing things.
But it needs to work for taxpayers, too. There’s no guarantee that the hospitals would spend their ‘profit’ on anything useful, and there’s a risk that we might just end up with yet more diversity officers. If there really is a more efficient system to be had then taxpayers should see the benefit in terms of lower overall costs. And that would require the Department of Health to set new, lower tariffs on the basis of the new cheaper way of delivering. After all, UK health spending is now fifth highest among the 38 rich economy members of the OECD with only the US, Japan, France and Germany spending more in 2022. Efficiency improvements should be harnessed to allow both an improvement in service quality and a reduction in the burgeoning cost of the UK’s health system.
Unfortunately, the department’s record in this respect is not encouraging. Twenty years ago the Blair government attempted an extensive NHS reform programme. The idea was to “invest” large amounts of taxpayer money against the delivery of substantial efficiency improvements. However, while the money got spent easily enough, the efficiency improvement lagged hugely. Instead, the NHS wage bill went through the roof, GPs and other staff reduced their hours, and a much vaunted and expensive computerised patient record system failed completely.
Might there also be a question as to how many other NHS hospitals would in reality be capable of successfully and safely operating the HIT system. Guys and St Thomas’ – both established way before the NHS was even thought of – are among the country’s top rated hospitals. They are centres of excellence, which sadly cannot be said of the NHS in general. Could a hasty roll-out nationwide end up with even heavier calls on taxpayers’ funds and perhaps even a deterioration in patient safety? Might a large increase in operating theatres’ output mean the closure of some, as a smaller number of theatres and staff are able to perform more operations? Doing more with less is what productivity and prosperity comes from but if that does happen then managing the transition will need to be considered.
The bottom line is that HIT sounds encouraging. But taxpayers should always be wary of public sector schemes involving extra spending today against vaguely defined promises of efficiency improvements tomorrow. The record is poor.