There is no doubt that COVID-19 has resulted in further challenges in elective demand, in this article we propose proven ways to kick start the elective recovery.
Prior to COVID-19, NHS 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 re-deployment of staff and beds taking place to increase critical care capacity. Constraints are set to continue as social distancing rules impact across all settings of care for the foreseeable future.
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. The NHS Confederation have estimated that it is likely to reach 9.8 million by the end of the year as a result of staff shortages and hospitals having to cap the number of patients they can treat at any one time because of strict physical distancing rules that reduce the number of beds available.
In the face of these challenges, a key question to ask is: are we using tools already available that are clinically proven, such as advice and guidance?
Managing the demand for non-urgent elective care, whilst continuing to operate with reduced capacity, will need to accelerate new ways of working. 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 significant opportunity to embed innovations such as advice and guidance within business-as-usual processes to establish system resilience.
Things to think about…
There are several considerations for those thinking through how to manage the existing backlog and expected growth in demand and embed the transformation they have delivered over recent weeks:
- Do we have a cohesive plan which brings together system wide stakeholders to formulate solutions and take action? There is now a requirement to embed crisis-induced good practice, whilst revisiting or re-instituting governance where there may be concerns about safety, appropriateness, or sustainability.
- What transformation can we keep, what needs tailoring – what else can we do to help in a time of limited resources? Are we optimising technology, remote consultations, ‘see and treat’, advice and guidance models and ‘referral support systems’?
- Can telephone and online advice help manage demand in hospital? NHS consultant level support can provide advice/photo-messaging for GPs and Care Providers, swiftly and safely, helping to avoid unnecessary hospital referral or admission. Innovation has been applied to provide enhanced advice and guidance in elective and urgent care, establish a national consultant network for remote advice and referral backlog assessment and provide specific teledermatology, ophthalmology and tissue viability advice as well as supporting remote working including for quarantined clinicians.
- What other settings and services can advice and guidance systems be used for? Further innovation is taking place in the application and extension of advice and guidance services to support virtual clinics, patient-initiated follow-ups (PIFU)/Safe early discharge, mental health services and for community users such as care homes.
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