The government has used its first budget to start delivering on its big manifesto promise for the NHS: to restore the ’18 weeks’ waiting time standard by delivering 40,000 extra elective appointments a week.

But extra activity is only part of the story. Waiting lists build up when activity falls short of demand, so demand is clearly important too. Why, then, do we hear so little about it?

Any mention of demand is often met with some eye-rolling and shoulder-shrugging. Sure, it would be great to have a healthier population, but that is decades away. Explicit rationing of healthcare is crude, ends badly, and has only ever worked in dentistry. The other kind of rationing is the waiting list, and we already have plenty of that.

While there is truth in those arguments, they contain a big, false assumption: that all ‘demand’ represents genuine patient need that the NHS must deal with. But there is another kind of demand, sometimes referred to as ‘failure demand’.

What if a patient needs a diagnostic test, followed by an appointment to discuss the results, but those events are booked in the wrong order? What if a patient has two clinical conditions, both of which require the same blood test, and ends up having the blood test twice? There are countless other examples. They represent a waste of everybody’s time and money, but in the usual NHS activity data they are indistinguishable from meeting genuine patient need.

To their credit, the government have their eye on this too, talking of: “reform to patient care pathways to deliver better patient experience for lower cost, enhancing patient choice”, and “NHS technology and digital to run essential services and drive NHS productivity improvements, to free up staff time…”.

Eliminating ‘failure demand’ lacks the glamour of a brand new surgical hub or Electronic Patient Record system. There is no ribbon to cut, and no ‘big bang’ go-live to issue a press release for. But for modest money and shorter lead times, it’s an investment that keeps delivering returns. It starts by joining up the existing data that is currently fragmented along elective pathways, to build a complete picture of what every patient needs next. Then, step by step, all those processes can be joined up, and the waste driven out.

To start driving out ‘failure demand’, drop us a line. Together we can lay out your step-by-step journey to lower waste and higher productivity.