How are other countries cutting pandemic backlogs?

Australia scaled back and at times suspended non-elective procedures from March 2020 to ensure hospitals had the capacity to cope in the event of an outbreak and a surge in admissions.

By 2022, the resumption of international travel and the spread of Omicron meant that staff were more likely to be off sick with Covid or beds were being lost - as they were in the NHS - to infected patients who had to be isolated.

Public hospitals in Australia carried out just 623,000 elective surgeries in 2021/22 - the lowest number in a decade, and 17 per cent fewer than during the first year of the pandemic in 2020/21.

READ MORE: Nearly 7000 Scots still waiting over two years for NHS ops 

Facing a similar predicament, a group of heart surgeons in Serbia came up with their own solution.

The medics, based at the Cardiac Surgery Clinic at the University Hospital of Niš - Serbia's third largest city, with a municipal population roughly the same as Aberdeen - asked the country's ministry of health to approve paid overtime to help them to clear waiting lists.

This request was reportedly ignored. Undeterred, the surgeons and their colleagues committed to doing the extra hours unpaid instead.

The medical team at Clinic for Cardiac Surgery in Niš, Serbia (Image: Twitter)

Over the course of 100 days, including 12 consecutive weekends, the staff worked voluntarily without any extra pay to drive down the waiting list for cardiovascular procedures.

Waiting lists which had been four to six months were gradually chipped away until, by April 10, they became 'appointment lists'.

Patients referred for treatment would be operated on within seven to 15 days - the standard timescale.

The whole initiative was spearheaded by institute's director, Dragan Milić, who hailed his team's achievement on Twitter.

He wrote: “In these 100 days, we performed a total of 248 operations, compared to the same period last year, when we did 117 surgeries. An incredible 98 operations were performed in March of this year alone.”

Fantastic and heartwarming news from Niš. Congratulations to my friend @drdraganmilic, and thanks to him and all his staff for this heroic effort. This is the true meaning of service to others. https://t.co/bB2yK0pTHj

— Ambassador Christopher R. Hill (@usambserbia) April 10, 2023

Milić noted that this had been delivered in the face of a year-on-year reduction in the numbers of anaesthetists, hygienists and paramedics, adding: “I’m proud of the entire staff of the clinic who persevered and endured this extremely fast pace and fulfilled the promise made to eliminate waiting lists.

"Since the weekend work was not paid, they proved that there are more important things than money – and that is caring for the patient."

Unsurprisingly, this accomplishment has provoked an outpouring of national pride as the Niš doctors were praised as heroes by their patients and the wider Serbian public.

But it has also provoked a backlash against the government for refusing to fund overtime in the first place, as well as some unease among other clinicians that it sets an unfair and potentially dangerous precedent.

Back in the UK, it would be difficult to imagine any department adopting the Niš model - nor should they be expected to.

But the question remains, how will the NHS clear its treatment backlogs - and just how long will that take?

READ MORE: Number of Scots going private for operations up by 73 per cent 

According to figures published on Tuesday, the number of elective procedures carried out on the NHS in Scotland from January to March this year remained 20% lower than it had been for the same three-month period in 2019.

A total of 52,089 planned operations took place - roughly 13,000 fewer than pre-pandemic levels.

By the end of December last year, there were still 6,856 people on NHS Scotland waiting lists for elective inpatient or day case surgery who had been waiting over two years, and 35,690 who had been waiting over a year - including 168 for a cardiology or cardiothoracic procedures.

Elective activity on the NHS remains well below pre-pandemic levels, with thousands of patients still waiting over two years for operations (Image: Public Health Scotland)

The next set of statistics is due on May 30, and the Scottish Government is under pressure to show tangible signs of recovery.

It previously pledged to eradicate two-year waits "in most specialties" by the end of September 2022, with waits of 18 months to two years supposed to be eliminated by the end of September 2023.

The network of National Treatment Centres - elective hubs vital to ramping up this activity - have begun opening, but remain behind schedule.

Meanwhile, England - with ten times the population - has all but eradicated two-year waits already.

By the end of January, there were just 1,122 patients on its lists for consultant-led elective treatment who had been waiting over 104 weeks.

This has been achieved by a variety of initiatives, ranging from an increase in robotic-assisted surgery to the creation of additional theatres and ring-fenced surgical hubs dedicated to performing thousands of low-complexity operations.

READ MORE: The rise of NHS-run GP surgeries - and why it matters 

Much more controversial, however, are reports that the UK Government is now drawing up legislation that would compel NHS trusts in England to send patients to private hospitals on a case-by-case basis as part of its drive to slash waiting lists further.

This may sound like good news for patients (many of whom are already dipping into their own pockets to pay for operations privately), but critics warn that it has the potential to "kill" the NHS.

Why?

At the moment, increased use of the independent sector has been largely restricted to ophthalmology and orthopaedics and on a 'block' basis, where a fixed capacity for NHS-to-private referrals is purchased in advance at a cheaper rate.

This new model may cut waiting lists, but at much greater expense using money from the existing NHS budget.

The UK Government is reportedly drawing up plans to increase the use of the private sector to help clear NHS backlogs in England (Image: PA)

The fear among opponents is that this approach will strip resources out of the NHS, ultimately resulting in an even poorer service while lining the pockets of commercial healthcare instead.

While Scotland's failure to clear waiting list backlogs fast enough is exacerbating two-tier healthcare between rich and poor, it would be ironic if England's efforts to do so at speed ended up unravelling the NHS as we know it.

Unless that's the plan?