“Senior doctors are charging the NHS premium rates for overtime, as pressure to cut waiting lists is allowing some to make more than £200,000 a year from additional work”, reports the BBC.

This isn’t only about the huge post-covid waiting list, as comments later in the article make clear. For decades the NHS has tended to pitch its core capacity a little too small to keep up with demand, which allows a backlog to accumulate that is periodically cleared with a ‘waiting list initiative’ at high marginal cost. It’s a bit like a household trying to save money on the weekly shop, and then ending up at the takeaway on a Friday because they’ve run out of food.

Why does this happen? Clearly it cannot be driven by a shortage of resources, because this approach actually costs more than keeping up with demand in the main working week. So it must be something more subtle.

One is short-term planning. For example, today is the 12th of November. Imagine we are managing several hospital services, and we notice that one of them is heading for a waiting times breach at the end of the month. At such short notice, our only option is to lay on extra capacity at overtime rates. (Had we seen this coming two or three months in advance, we might have been able to juggle things within existing resources.)

Another is long-term planning. If the big investment decisions are not accurate – such as whether to replace a consultant who is retiring – then service-level core capacity will drift away from changing demand patterns, and backlogs will grow (or shrink) unevenly across the hospital. (If we had trustworthy long term planning, then we could make better investment decisions and reduce the drift.)

There are other causes, but the point is made: better planning means better core capacity allocation, and avoids us spending quite as much money on extra capacity at high marginal cost.

This matters right now, because the annual planning round is getting underway. Here at Insource, we have the advanced and reliable tools you need for both short and long term planning. So drop us a line – there is still time to deploy them, so that 2025-26 can play a full part in your multi-year recovery of the 18 weeks waiting time standard.