Three sets of figures: three things they tell us about the NHS…

Last week saw a trio of datasets published about different parts of the NHS, all highlighting issues in different places in the system but all painting a clear picture of the brute forces stressing our health service like it's never been before:

• The first was data on the number of people attending Accident and Emergency departments in September, and the proportion of those who waited four hours or more for their treatment. More than two million people went to A&E last month, which is a 25.7% increase on the same period last year. It took more than four hours for almost one quarter of people to be admitted, transferred or discharged - the highest figure since this data was first collected more than 15 years ago.
• The second was data on appointments in general practice in August. This showed that there were 25.5m appointments delivered by GP teams that month, and that 58% were face to face. Government announced that it is making £250m of extra funding available to primary care to support recruitment of additional temporary staff to help, but only for practices providing a specific level of access to in-person care where appropriate.
• The third was data on the NHS's annual analysis of its buildings. This report, which collects data on hospital and ambulance sites, not GP and wider primary or community health buildings, showed that the 'backlog maintenance' - or the amount of spend that would be needed to catch up on all of the estate work which should have already been carried out to keep NHS hospitals and other Trust sites fit for purpose - has now reached £9.2bn, another rise on last year.

One of the threads which tie these data sets together is the NHS's space: the places it has at its disposal in which to carry out face to face tests, treatments and consultations; the workplaces it has for the staff it has now, and the workplaces it wants for the staff it needs to recruit, to deal with the current pressures and deliver on its longer-term goals for care.

It is clear from GPs themselves and sector bodies that to 'do more' in primary care - to house more services away from hospitals, free up invaluable space at acute sites so that the sickest patients can be helped there more quickly, and to build capacity in the community, not least to help address the backlog created by the pandemic - will take the right kind of infrastructure. The King's Fund describes technology and the estate as the twin enablers of change, and the pandemic has demanded much of both. The challenge now is to harness them, to support delivery of the truly hybrid model so that patients get the right route for their needs.

These data sets are indicative of the challenges facing both the NHS's virtual and physical space. GPs estimate that only half of surgery buildings are fit for purpose, simply unable to cope with the volume and complex needs of the patients they now need to serve. The virtual space is full of potential, but it needs to be used in the right ways for the right patients. As the College describes it : "Remote consultations will remain an important way of delivering general practice services in the future, both as we continue to manage COVID-19 and more generally, but as we look beyond the pandemic, we expect a rebalancing between face-to-face and remote consultations. Face-to-face appointments will always remain a major element of general practice, and remote consultations will continue to be delivered where appropriate and useful. The mode of consultation should be determined through shared decision-making between a patient and practice staff."

From a patient perspective, our own research with both the Patients Association (on patients views of returning to face-to-face GP appointments and on primary care spaces more generally) and the national disability charity Dimensions have shared the perspectives of GP space from the other side of the reception desk.

Data paints a picture, but the NHS is fundamentally about people: those it serves, and those who work within it. Really listening to their experiences and shaping those twin enablers of estate and technology around their needs is a huge and currently untapped opportunity for a government wanting to level up the experiences and outcomes of patients and healthcare, and the working lives of NHS professionals.

Claire Rick is our Head of Public Affairs.