ICSs fail to meet targets for increased elective activity, despite £120m funding

Twelve Integrated Care Systems (ICSs) which received £160m from NHS England to increase the number of elective procedures they perform have so far failed to bring them up to pre-pandemic levels, according to an analysis by HSJ.

Earlier this year NHS England chose the ICSs to take part in an accelerator programme that would speed up their implementation of elective (planned) procedures such as hip operations or biopsies.

ICSs taking part in the programme told HSJ that when they received the money, they had been asked to commit to delivering 120% of their pre-Covid activity levels from July onwards.

In practice, not only did they fail to meet the 120% target, many failed to return to their pre-Covid levels. HSJ said this was supported by an analysis of NHS Digital activity data from July to September, which showed that all 12 delivered fewer in-patient and day case procedures than in the equivalent period in 2019.

Analysis of the data for the three-month period to September shows all 12 systems in receipt of the extra funding delivered fewer inpatient and day case procedures than they did in the same period in 2019.

The highest performing ICS was Nottingham and Nottinghamshire, which reached 97% of pre-pandemic levels, and the lowest was Lancashire and South Cumbria (86%).

In the spring, national elective procedure activity stood at 85% of pre-pandemic levels nationally, increasing to 96 per cent in June.

Workforce issues hamper ability to increase procedures

Although initially performance seemed to be on an upward curve, it was hit by a big increase in the number of Covid patients at the end of June. Since then, the proportion of acute beds occupied by Covid-positive patients has remained static at about 4%. Combined with high staff absence rates, the requirement for infection control measures, difficulties in discharging patients and emergency pressures, this has made it harder to increase the number of elective procedures.

The HSJ analysis did find that the accelerator areas performed marginally better than other ICSs during the three month period, at an average of almost 90 per cent of pre-Covid procedures, compared to the national average of 87%.

Barry Mulholland, a partner at MBI Healthcare Technologies, told HSJ: “I think this tells us two things. Firstly, despite central investment, particularly relating to accelerator programmes, trust’s elective activity remains hampered by their estate and workforce.

“Throwing more money at the issue will only get you so far. At present, where it gets us is not even back to pre-pandemic levels for the majority of ICS footprints. Secondly, with that in mind, the lead-in-times for solving estate and workforce issues will be longer than anticipated. The direct consequence of that is that the waiting list will continue to grow and patients will continue to wait.”