Waiting times in ENT- a new year update from GIRFT

10 January 2024 (Last updated: 23 Jan 2024 10:29)

Christmas has just passed and the New Year begins so time for a bit of good news! The outpatient over 52 week waiting list is coming down, all be it slowly. The 'Further Faster' initiative to clear long waiters by end of March for all specialties is having an effect. Trusts have been recruited with an undertaking from their CEO to trial and adopt GIRFT measures and assess effectiveness. So far, 25 trusts in the first cohort have reduced 52 waits by 15% in the first 6 months across all specialties, whereas all other trusts have seen a 4% increase.

In ENT, since July we have reduced over 52 week waits by 10% in all trusts and the 'Further Faster' trusts by 17%, which is very encouraging. The most effective quick fix is validation, and most ENT units are validating waiting lists effectively so keep it up. Consultant triage of new referrals is also very effective, as is reduction of DNAs for outpatients and operations. Proactive administration measures such as texting, utilising systems such as AccurX or simply phone calls are inexpensive interventions.

The outpatient waiting list is still enormous and rising, at over 700,000 at time of writing. The facts show that referrals outstrip capacity, and this has been gradually worsening over the past 10 years. In 2013 there were about 200,000 on the outpatient waiting list, by 2019 this had gone up to 350,000 and then Covid doubled it. About 40% of new referrals are uncomplicated hearing problems and simple perennial rhinitis, and others include wax, presbyacusis, tinnitus and a runny nose.

The conversion rate to surgery in ENT has fallen from 20% to 10% in 10 years. We must realise that we cannot offer a comprehensive ear and hearing health care service based in hospitals. We must develop primary or intermediate services that can deal with the simple and recognise the more complex. Ideally this would be in the community, not in hospitals for a number of reasons: ENT departments don’t have the room, ENT units often are a significant distance from residential areas, parking at hospitals is inadequate and frustrating, public transport is often unreliable or non-existent. There are examples of ear care in the community but they are few. The Tympa health project has been successfully trailed in London, utilising pharmacists to clean and examine ears with a digital camera link to local ENT services. We need to develop a program training health care workers to clean ears and diagnose simple problems, test hearing and provide hearing aids.This can function as an extension of the audiologist role but they are in short supply. There needs to be a national initiative to tackle this issue now, as it can only get worse.

There is a huge and unexplained variation in the incidence of Septoplasty between ENT providers, by as much as a factor of 5. This is raising questions about it’s value and the rational for carrying it out. The recent NAIROS study does show symptomatic benefit in patients with a high NOSE score, but because this procedure is the main reason for long waits in ENT due to it's low clinical priority, it has come under scrutiny. As a result, it may be restrictedby commissioners alongside other procedures such as snoring surgery. Many clinicians have felt it is over prescribed, criteria for carrying it out too vague and little documented in the way of outcome measures, outside of specialised units. Further discussion is needed about the application and effectiveness of this procedure, particularly with guidance to trainees.