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Getting back on track: revolutionising NHS elective service provision

Let's talk about the tangible approaches and real life examples of how the NHS can change it's approach to elective services to tackle a fast growing waitlist

I hope you liked the comparison I made between the growing waitlist for surgery and Olympic swimming in my previous article – and the idea that a transformational change in approach is required when you fall demonstrably behind.

If the NHS is currently the epitome of a burning platform - an increasingly exhausted workforce (already working heroically hard), with a waiting list for elective surgery that looks set to more than double to 10.8 million by the end of the year (at least), and ever stretching finances – what can we do to get it back on track? 

Getting back on track: revolutionising NHS elective service provision

Going back to how things were before COVID-19 isn’t an option, and even working at normal levels of provision, or slightly higher, won’t return services to acceptable levels.

Well I’m pleased to say that there is good news.

At the PSC, we’ve been working with at lot of talented and motivated teams across different health settings and geographies who are reacting to the current circumstances and trying to do things differently.

Let me talk you through a few of the most promising and exciting new approaches to elective service provision that we’re currently working on.

Pooling resources

With such a heavy focus on recovery and managing capacity for elective services post-Covid, two hospital Trusts in the South East of England plan to take a different approach by working in partnership.

Their aim is to join together to understand their combined capacity and deliver a near-live planning tool to help each speciality across the Trusts make better decisions. They're working out how to roll this solution out across their Integrated Care Partnerships, pooling waiting lists and resources from 6 acute hospital sites to provide a better, faster service.

Risk-based prioritisation of patients

When resources are so stretched, it’s never been more important to ensure they’re directed towards patients that need them most.

Imperial College Healthcare NHS Trust has developed a framework that enables prioritisation based on clinical priority and risk of harm, whether actual or potential. Every encounter, whether that be in outpatients or within a waiting list clean-up operation, provides an opportunity to use the framework without scheduling additional reviews.

Decisions can be modified for patients whose underlying conditions put them at high risk of COVID-19 infection or COVID-19-related morbidity and mortality. The framework prioritises patient safety and can be used to support the prioritisation of patients in different settings, with different diagnoses, and even under the care of different Trusts.

Re-designing outpatient pathways

A host of changes were introduced to deal with the immediate effects of COVID-19 on outpatient services. Telephone consultations, virtual clinics and new methods of communication that went beyond the humble clinic letter were launched.

Many of these changes had a positive impact, so to lock these innovative ideas into the ‘new normal’, individual services, such as cardiology, are now redesigning their patient pathways to allow patients to be seen in a more timely, convenient, and efficient manner.

These new models of care sit alongside larger changes such as plans for local diagnostic centres which will help patients get x-rays, CT-scans or MRIs in a safe, virus-free environment.

Race to the wall and beyond

When returning to the status quo is not an option, the wheels are put in motion for a major shake-up of service provision within the NHS. From strategic partnerships across Trusts, to better patient prioritisation and use of innovative technologies, there’s a lot of be positive about.  

We would love to share these developments in best practice so do get in touch.

We may still be swimming to catch up but catch up we will.

Author: Mike Meredith

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