Forty thousand more appointments per week and ‘surgical hubs’, but will this fix the NHS?

Chancellor Rachel Reeves’ debut budget pledged increases of^[1] £22.6 billion in day-to-day spending for the NHS and £3.1 billion in capital spending over the next two years. The increase in day-to-day spending is intended to fulfil Labour’s campaign promise of “40,000 more appointments per week” from their election manifesto.

This often-repeated promise gives the government a tangible short-term goal in its longer-term mission to meet the 18-week target^[2] for elective care. However, while 40,000 additional weekly hospital appointments may sound impressive, a closer look at NHS statistics suggests that this increase is less significant than it first appears.

NHS England conducted about 2 million outpatient appointments per week in 2023-24, meaning that 40,000 more appointments per week would represent only a 2% increase.In recent years, the average annual increase in weekly outpatient appointments has been 2.9%, meaning that an extra 40,000 appointments per week would be a slower than usual increase.

The chart below shows the average number of outpatient appointments per week for each financial year since 2013-14, with a red point indicating an increase of 40,000 per week for 2024-25.

Average weekly outpatient appointments in NHS England, 2013-14 to 2023-24

Author's calculations from NHS outpatient activity data While day-to-day NHS spending is promised the largest increase in funds, the increase in capital spending is proportionally greater^[3] as it increases from a lower base (10.9% increase per year over two years for capital spending, versus 3.4% for day-to-day spending). This boost is an important development, because some recent policy analysis of the NHS emphasises how far behind^[4] it is in capital spend. In particular, the Organisation for Economic Co-operation and Development^[5], which has 38 rich country members, has noted that the UK has fewer diagnostic scanners, such as MRI machines, compared with other developed countries. This may be why the chancellor specifically dedicated some of the new capital spending to new diagnostic equipment. Her budget directs some of the new capital funds towards developing more community diagnostic centres (CDCs) and “surgical hubs” – two types of facility that have emerged in recent years. I am a part of a research team at the University of York that has analysed data^[6] on CDC performance. My colleagues and I are also working on a project^[7] to evaluate the surgical hubs programme. Both of these types of facility share common features. They aim to ring-fence staff, buildings and equipment for elective (planned) care, separate from major hospital sites that deal with emergency patients. Surgical hubs are facilities designed for elective surgery, such as hip replacement operations or cataract surgery. These hubs can either be part of an existing major hospital site^[8] or a stand-alone facility, such as the South West Ambulatory Orthopaedic Centre^[9], built on a new hospital site initially developed as a “Nightingale” hospital during the COVID pandemic. Similarly, CDCs are stand-alone facilities for planned (non-emergency) diagnostic tests and scans, such as those used for diagnosing cancer or heart problems. They are designed to be located away from major hospitals in more convenient community locations. Examples include the Askham Bar CDC, located in a supermarket car park in York, and the Wood Green CDC, located in a shopping centre in north London.

References

1. ^{^} increases of (www.gov.uk)
2. ^{^} 18-week target (labour.org.uk)
3. ^{^} proportionally greater (www.kingsfund.org.uk)
4. ^{^} far behind (www.nhsconfed.org)
5. ^{^} Organisation for Economic Co-operation and Development (www.oecd-ilibrary.org)
6. ^{^} analysed data (www.sciencedirect.com)
7. ^{^} working on a project (measure-study.org)
8. ^{^} existing major hospital site (mft.nhs.uk)
9. ^{^} South West Ambulatory Orthopaedic Centre (nightingale-exeter.nhs.uk)
10. ^{^} recent paper (www.sciencedirect.com)
11. ^{^} early evaluation (www.health.org.uk)
12. ^{^} increase awareness (link.springer.com)