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Research and development are changing medicine, although there are views that new treatment can add to demand and waiting lists, as well as streamline care.
In December 2023, the BBC ran a feature on a young lady who waited four years to see an NHS dermatologist. The Covid pandemic exacerbated her wait but even so, the problem looked to be more systemic.
The patient was initially diagnosed with psoriasis in 2017 and referred for specialist care in 2019. This did not take place until September 2023.
A long wait which could increase stress, or symptoms, for an often chronic condition, with physical and psychological effects. The question was whether this case was an anomaly, or represented the norm.
An Overall Picture
As the case happened in Scotland, the BBC focused on Scottish data. Public Health Scotland confirmed that waiting lists in Scotland have grown to a record high, with more than 670,000 people waiting to see a specialist for non-urgent care.
Cardiology, neurology and dermatology were the specialisms with the greatest increase in appointment delays, with dermatology the worst. The Scottish Government’s standard of patients being seen within 12 weeks of referral looking doubtful.
The timing of the case mentioned above straddled the pandemic and may be unusual but general data suggests that the 12 week principle is not realistic. Neither is the position notably better for the NHS in England.
A random check on NHS hospitals across England brought an average figure of 43 weeks, for a dermatology appointment and commencing treatment. The NHS Constitution states that for routine conditions, treatment should commence within 18 weeks.
Proposed Reasons
There has been industrial action over the last year and none of us can forget the Covid pandemic, which in a sense eliminated waiting list entry. Lists have then grown again since the pandemic, with people coming forward in larger numbers.
The combined effect has taken the national waiting list for elective care to 7.7 million, triple the number in 2013. We should however note that 4.6 million were already waiting by 2019, almost double the 2013 figure.
Additional factors to the pandemic and industrial action have been raised. They include loss of staff due to Brexit, more consultants working part time, similar issues and other workload pressures for GPs.
We have no wish to judge individual views, the reality may be a combination of these and other factors. Some have mentioned the possibility of efforts to cure the problem making matters worse for certain patients.
Prioritising Care
The post pandemic situation understandably left the NHS with a view that clinical prioritisation was needed. In dermatology they provided a detailed approach, down to scripted communication and discussion with patients to determine their position.
Skin cancer was given a high priority, as should be the case, although hospital dermatology services have stated that a need to concentrate on skin cancer made recovering lost ground harder in other areas.
There have also been suggestions of a shift in the perception of what should be treatable on the NHS, or viewed as a cosmetic need.
The Outcome For Patients
We agree that skin cancer deserves urgent investigation and care. A disease which responds well to prompt treatment and in some cases is life threatening, even shorter NHS waiting times would be welcome.
The issue is that patients with other life altering skin conditions are pushed back. Many of those would also respond to early treatment, will worsen without this and be subject to a range of secondary effects.
People with worsening eczema, psoriasis and more can suffer psychologically as well as physically. They could withdraw from society, cease to work, or see their quality of life deteriorate in a variety of ways.
The same can apply to those whose conditions have been categorised as cosmetic, particularly if the issues are visible.
Looking For Solutions
On the NHS, we could give a variety of thoughts, perhaps on recruitment, retention and work patterns. Those thoughts do however come with a caveat, the NHS is full of committed people and they are doing their best.
An increasing number of patients are solving the problem by turning to private care, where they can be seen and treated in a fraction of the time.
We make them welcome and offer high quality dermatological treatment, aimed at seeing lives quickly return to normal. Patients are pleased with the outcome but as we do, may spare a thought for those who are unable to access our support.
As with most people in the UK, every member of our staff wants to see the NHS back on track, bringing essential care to the people of our country.