Elective Care: The Road to Recovery

Prior to the advent of COVID-19NHS waiting lists sat at a 10 year high with 4.4 million people waiting for elective care. Over 16% had waited more than 18 weeks and 1,613 people had waited over 52 weeks. Historically, outpatients represent 85% of all UK hospital-based activity – excluding A&E 

From April this year, NHS England required hospitals to postpone non-urgent elective care with a massive re-deployment of staff and beds taking place to increase ICU capacity. Concerns have now been expressed by the Royal College of Surgeons that it may take up to five years to clear the backlog in elective care. 

During the crisis, many organisations temporarily relaxed the criteria around different processes to accelerate the adoption of innovations such as digital consultation technology and to scale-up the use of virtual outpatient clinics. There is now a requirement to embed crisis-induced good practice and innovations within business-as-usual processes, whilst revisiting or re-instituting governance where there may be concerns about safety, appropriateness, or sustainability.  

Things to think about… 

There are several considerations for those thinking through how to address the backlogs and embed the transformation they have delivered over recent weeks: 

  • Do we really have the in-house capacity to address our backlog? Do we need to appraise the different Make-Share-Buy options for increasing elective care capacity? If so, how do we balance decisions around investing in growing internal capacity, working in care system partnerships, and/or sourcing additional capacity from the independent sector? 

  • How can we manage our waiting lists and make sure that we are prioritising care for the right people? How do we balance list cleansing, validation, profiling, and re-prioritisation – and make sure we are in line with NHS England Covid19 related guidance and restrictions? 

  • Have we considered the likely ‘bounce’ in presentations for elective care in the coming weeks? How is this likely to impact on demand and capacity and our ability to manage hospital services, including diagnostics, beds, and theatres? 

  • What transformation can we keep, what needs tailoring – what else can we do to help in a time of scarce resources? Are we optimising technology, remote consultations, ‘see and treat’, advice and guidance models and ‘referral support systems’? 

  • Should we be considering the use of ‘Hot and Cold’ sites to accommodate Covid19, emergency and elective care patient cohorts, potentially across organisations? 

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All this work will sit alongside the need to respond to future spikes in Covid19 and the impact of this on the ongoing balance between urgent and elective provision. To get through the next phase of recovery, organisations will need to undertake a process that can best be described as new business-as-usual transformation’.  

Attain can support organisations and systems with all aspects of the work now needed around elective care, including planning, capacity and demand modelling, models of care and pathway redesign, and workforce solutions. There are some huge challenges ahead of the NHS and we want to use our wealth of skills and expertise to help you to meet them. 

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