NHS Supply & Demand: Closing the Gap14th November 2022
The supply and demand imbalance playing out across UK healthcare is delaying both diagnosis and treatment for many conditions, creating significant issues for patients.
In this article, CIL’s Healthcare practice explores how innovative solutions are helping increase capacity in radiology, whilst opening opportunities for independent sector providers and investors.
Setting the scene
NHS waiting lists have reached historic highs, with the backlog in England currently estimated to stand at approximately 1.5 million surgical procedures and 5.5 million out-patient appointments. Factoring in a ‘hidden’ waiting list of people not currently on the waiting list, but should be, means the overall list is estimated to be higher.
Clearing the backlog is proving challenging, with the NHS reported to be delivering 5-10% less activity than before the pandemic, as capacity continues to be taken by COVID patients, and residual infection control protocols limit throughput.
As activity levels grow, tests that help clinicians make a diagnosis, and then confirm that conditions have been cleared following treatment, are likely to be in increasing demand.
An example of this is radiological examinations, where prior to COVID 10-11 million MRI, CT and other complex scans were being performed each year, growing 6% CAGR 2012-19. This trend appears likely to continue, driven by the need to clear the backlog, and the UK having an ageing population increasingly at higher risk of cancer, cardiology and musculoskeletal diseases, where radiology plays an integral part of the care pathway.
To meet this increasing demand, the NHS will likely need more imaging equipment and staff. The UK currently has among the lowest number of medical imaging scanners per one million people in Europe, and a shortfall in the required numbers of consultant radiologists and radiographers required to operate the scanners and report on the images.
Government funding has been committed to help improve physical capacity. The Elective Recovery Plan, published in February 2022, ringfenced £2.3bn to invest in the capacity required to deliver a further 10 million diagnostic tests (including radiology examinations) by 2025. This is partly to be delivered through 160 Community Diagnostic Centres of which 90 were reported to have opened by June 2022.
Resolving staffing challenges could be a bigger test.
In 2021, The Royal College of Radiologists estimated there was a shortfall of ~1,700 full-time consultant radiologists (who interpret radiology images), with this figure predicted to grow to ~3,200 by 2026. To close the gap would require the current consultant radiologist workforce to nearly double in size by 2026.
This is likely to prove challenging, as consultant radiologist numbers have been growing modestly, at 4% CAGR 2013-21, and other specialties are equally competing for medical students to specialise in their areas to close their workforce gaps.
Meanwhile, radiographers, who perform the scans, are also in high demand. The Department of Health and Social Care estimates a further 3,500 will be required to staff the new community diagnostic centres, an increase of approximately 10% on current workforce levels. This number could increase further should some radiographers continue to fill the radiologist shortfall, by reading some simpler scans such as X-Rays, taking time away from their core role in operating scanners.
In parallel with ongoing recruitment, radiology is a good example of where solutions are being sought to help close the gap between demand and supply.
The majority of NHS Trusts in England now outsource a proportion of their radiology reporting using teleradiology. This enables hospitals and imaging centres to share images with UK-qualified consultant radiologists nationally and internationally, who complete the reporting from high-spec home workstations, providing extra capacity. This is particularly used out-of-hours, enabling radiologists on site at the hospital to focus on alternative activities, such as training junior doctors and performing image-guided procedures, which help treat patients. This model has also been used in Scotland, with NHS Scotland reported to have developed its own solution to allow its radiologists to review and report scans across Scotland from home.
Analytics and risk stratification
Advances in analytics and risk stratification have started to help focus demand on patients most in need. By predicting the likelihood of certain results using vast health population sets, patients can be prioritised for testing based on perceived risk levels, theoretically reducing the complexity of treatment required, as higher-risk patients have their conditions diagnosed earlier.
The emerging fields of genetic and precision medicine may help further, by enabling treatment regimens to be tailored to individual patients. This could improve outcomes, reducing the amount of follow-up radiology required.
Over time, these fields may be supported by artificial intelligence and machine learning, however, these areas are currently nascent and require further validation. There are also emerging challenges regarding how data is gathered and used in line with GDPR and the need to protect patient anonymity.
Physical and workforce capacity support
Third-party providers are also supporting the NHS by adding additional capacity. Examples include mobile scanning units, which are now frequently found in hospital car parks, and organisations that can provide flexible resourcing support, such as staffing agencies and insourcing firms.
Independent sector providers are also finding themselves well-positioned, either to deliver outsourced work on behalf of the NHS, or by servicing an increasing number of private payors who choose to fund care (whether directly or through private medical insurance).
Advice for businesses and investors serving the sector
While these solutions provide opportunities for companies to support the NHS, businesses and investors should be aware that selling into the NHS does not fit a conventional B2B model. It has its own rules of engagement.
Businesses and investors in the sector should be sure to articulate the benefits of their proposition in a way that is meaningful to the relevant stakeholders, in a language the NHS understands.
Thinking at a system level is also important – for example making sure your solution does not inadvertently exacerbate problems elsewhere in the health system. Early engagement with a range of key decision-makers, who can help test and refine your proposition is recommended.
A common pitfall is to consider the NHS as a single entity – there is no ‘front door’ to the NHS. Decision-making can occur at multiple levels (from departmental management to C-suite), across multiple functions (e.g. operations, finance, procurement teams) in different parts of the NHS ecosystem (e.g. NHS England, Integrated Care Systems/Boards, NHS supply chain, individual NHS providers). It is important to understand who the ultimate decision maker is, whose budget pot the funding will come from (noting this may not be the decision maker’s) and which other stakeholders are key influencers.
The fragmented nature of decision-making and funding allocations can make initial barriers to entry low, presenting opportunity. Enterprising staff within the NHS are often on the lookout for innovative solutions and can have access to small funding pots to support local improvements. Scaling can prove trickier, however, as the NHS may not have a relevant individual or team responsible for rolling out a solution across multiple providers/geographies. This can lead to the need for a sizeable sales team, who can identify and target the numerous relevant individuals and have bespoke discussions. Or, where there is scope for a regional/national solution, procurement processes can be cumbersome and hard to navigate, particularly for newer providers into the NHS.
Overall, when offering solutions to help close the NHS demand and supply gap, clarity over proposition and benefits, and a targeted procurement approach are likely to be important in helping ensure defensibility.
If you would like to discuss any of the points raised in this article, please get in touch.