Hospital productivity is rising at quite an impressive rate. NHS England reported that hospital productivity grew by 2.7% in 2024-25, which is something to celebrate.

However, waiting lists have barely budged. It's clear the productivity increase in hospitals is not having the intended effect.

There are multiple long-term reasons for this, such as the rise in chronic conditions and an ageing population, but the main reason for the crisis is that we're not tackling the crisis at the source. 

The main crisis management approach has been to add additional capacity in hospitals, given the challenges of staff shortages across most specialties. However, we rarely step back and ask why so many patients are being referred into hospital pathways unnecessarily in the first place.

Long waiting lists are not a product of hospitals working inefficiently, but they are created much earlier in the patient journey, often in primary care, ambulance services or community settings.

Sometimes, clinicians might not initially know how best to treat a patient, but they can't get timely specialist advice. In times like this, the safest option is to send a patient to hospital, even if this might turn out to be unnecessary in hindsight.

It doesn't matter how efficient we make hospitals; if we keep sending hundreds of thousands of patients to hospitals that don't need to be there, hospital staff will never stand a chance of cutting waiting lists.

The Government has made a good start to tackle this problem by allocating more than £200m over four years to deliver 40-50 neighbourhood health centres. It's promising they're trying to keep people out of hospital, but it won't be enough by itself.

The real underlying issue is the system is not working in a way that encourages NHS staff to send patients to these centres. NHS trusts and ICBs are locked into the mindset of sending patients to hospital and we're not giving them enough reasons to think differently.

One factor that would help greatly is to change the money flows. Currently, hospital budgets are linked to how many patients they see in hospital. This means there is very little incentive to explore alternative pathways, such as virtual care or redirecting care into the community, even though it can provide numerous benefits to patients and take pressure off hospital teams. 

There's plenty of models out there that can help achieve this. Enhanced Advice & Guidance (A&G) solutions, such as Consultant Connect, allow consultants to quickly assist their primary care colleagues and find the right care pathway for the patient straight away. This results in over two-thirds of patients avoiding hospital and getting management plans to start treatment immediately.

While the Government has started paying GPs £20 each time they seek A&G, most hospital teams aren't compensated for delivering this type of work. The compensation system encourages them to see as many patients in hospital as they can, which is not in the best interests of the patient, NHS staff and or taxpayers.

We can't expect consultants to behave differently and encourage primary care clinicians to send patients to neighbourhood health centres if the money flows and performance metrics don't reward them for doing so.

Changing pathways takes time, effort and upfront investment. Hospitals have been the centre of gravity for so long in the NHS the financial incentives will have to be re-jigged to encourage consultants to go out of their way to keep patients from going to hospital.

We have the tech and the expertise to win the waiting lists war. However, we're fighting a losing battle by doing it in hospitals rather than in the community. Hospital staff cannot stem the tide by themselves, no matter how efficiently they're working. 

We need to help them out and transform the system so we incentivise doctors to help take advantage of neighbourhood health centres. Much of the approach to NHS reform has relied on stick rather than carrot, with targets, pressure and scrutiny dictating NHS activity so far. But we need to give doctors more carrots if we want to drive lasting change.