The NHS has announced a £160m initiative to tackle waiting lists and develop a blueprint for elective recovery as early reports show the health service is recovering faster after the second wave of the Coronavirus pandemic.
Indicators suggest operations and other elective activity were already at four fifths of pre-pandemic levels in April, well ahead of the 70% threshold set out in official guidance.
That was despite NHS staff still dealing with thousands of COVID patients; having to take additional steps, such as infection control measures, to keep patients safe; and rolling out the largest vaccination programme in health service history.
With COVID cases in hospitals now significantly reducing thanks to the extraordinary success of the NHS vaccination programme, our focus is now on rapidly recovering routine services
NHS England is now seeking to accelerate the recovery by trialling new ways of working in a dozen areas and at five specialist children’s hospitals.
The ‘elective accelerators’ will each receive a share of £160m along with additional support to implement and evaluate innovative ways to increase the number of elective operations they deliver.
Over the next three months tens of thousands of patients in those areas are set to benefit from initiatives that include a high-volume cataract service, one-stop testing facilities, greater access to specialist advice for GPs, and pop-up clinics so patients can be seen and discharged closer to home.
Virtual wards and home assessments, 3D eye scanners, at-home antibiotic kits, ‘pre-hab’ for patients about to undergo surgery, AI in GP surgeries, and ‘Super Saturday’ clinics – where multi-disciplinary teams come together at the weekend to offer more-specialist appointments – will also be trialled.
The aim is to exceed the same number of tests and treatments as before the pandemic and develop a blueprint for elective recovery to enable hospitals to go further and faster.
Amanda Pritchard, NHS chief operating officer, said: “Treating around 400,000 COVID patients over the past year has inevitably had a knock-on effect on non-urgent care, but our incredible staff still managed to perform more than two million operations and other treatments in the first two months of this year when the hospitals were at their busiest with COVID patients.
It will take both innovation and collaboration to reduce the huge waiting list that has built up over the last year
“With COVID cases in hospitals now significantly reducing thanks to the extraordinary success of the NHS vaccination programme, our focus is now on rapidly recovering routine services.
“Early figures show local teams are already well ahead of schedule, but we want to go further, faster, which is why we are investing £160m to find new ways to tackle waiting lists.
“The additional support will help us create a blueprint for continuing that progress over the summer and beyond, in a way that doesn’t heap extra pressure on staff, so that as many people as possible benefit from the world-class care the NHS provides.”
Thanks to its agile response to COVID-19, and the hard work of staff to keep non-COVID services going, the NHS has been able to deliver more than 12 million planned operations and procedures, and over 19 million key diagnostic tests since the beginning of the pandemic.
And, despite caring for a far-greater number of COVID patients in the second peak; hospitals also maintained high levels of planned care compared to the previous year, and average waiting times for planned surgery have fallen by almost 40% from July 2020.
The number of treatments delivered in January and February was over 800,000, or 70% higher than during the height of the first wave.
GPs, specialists and their teams are focusing on those in greatest clinical need and who have been waiting longest, with an additional £1billion funding already announced, available to trusts.
Other interventions being supported to help NHS teams go further and faster on recovering elective services include:
- North London Partners ICS will extend NHS operating hours, as well as using the independent sector, and offer patients care in newly-designed surgical hubs
- Devon ICS is repurposing the Exeter Nightingale to perform diagnostic tests, and patients in the South Wet will benefit from the extension of virtual wards so patients can receive medical support from the comfort of their home, freeing up beds in the process so more patients can be admitted to receive elective care
- Lancashire and South Cumbria ICS is using AI to prioritise and identify the right level of care and support needed for patients on the waiting list
Professor Neil Mortensen, president of the Royal College of Surgeons of England, said: “We welcome the announcement of funding for accelerator sites to explore and test new ways to get the elective backlog down.
The lengthening of waiting times due to COVID-19 has been well publicised, and patients are anxious about what this will mean for them
“It will take both innovation and collaboration to reduce the huge waiting list that has built up over the last year.
“2020 was incredibly challenging for the NHS, but in the midst of the pressure, staff and hospitals came up with new solutions to keep urgent surgery going.
Operations were scheduled at weekends, ‘surgical hubs’ were created, and groups of hospitals worked together providing ‘mutual aid’ to each other.
“And embedding the learnings and innovation is key to the future sustainability of surgical services.”
Professor Helen Stokes-Lampard, chairman of the Academy of Medical Royal Colleges, adds: “The pandemic has been truly awful for all of us. But, as the pressure begins to ease and we start to build back our NHS, we need to capture some of the good that came out of the last 12 months – be that through better use of technology, streamlined appointment booking, more-efficient ways of working – the list is almost endless.
“This investment is incredibly welcome and will be very well received, not least because it allows our brilliant staff to map out a way forward with better systems and services that will genuinely improve the quality of care and their lives easier.”
And Rachel Power, chief Executive of the Patients Association, said: “The lengthening of waiting times due to COVID-19 has been well publicised, and patients are anxious about what this will mean for them.
“This worry comes on top of the impact of having to live for longer with the pain or discomfort of their condition, and for many is compounded by having had multiple appointments postponed or cancelled.
Every NHS trust should be examining processes to prioritise what can, and should, be automated and taken off overstretched human workers
“Steps to accelerate the recovery of elective treatment are therefore very welcome – the importance of treatment being timely, to ensure the best-possible outcomes, is well recognised.
“Effective communication with patients at this critical juncture is also essential, and we have been pleased to work with NHS England on developing principles for effective communication with patients about their elective treatment.”
Welcoming plans to increase the use of digital solutions to help with this initiative, Richard Farrell, chief innovation officer at software specialist, Netcall, told BBH: “This announcement is a stark reminder that we are not out of the woods just yet.
“Firefighting has been the priority over the last year, with multitudes of consultations, procedures and surgeries postponed.
“To overcome this, and improve the patient experience in the new normal; optimum efficiency, powered by automation, will be critical.
“Every NHS trust should be examining processes to prioritise what can, and should, be automated and taken off overstretched human workers.
“In addition to high-level patient and employee-focused processes, this includes going back to basics and utilising RPA and low-code to automate tasks such as invoicing processing, back-office administration, and operations across various departments.
“Not only will this increase efficiency and help alleviate patient backlogs, but it will also give healthcare staff more time to focus on what really matters: patient care.”
But Lauren Bevan, head of health and social care at business technology consultancy, BJSS, raised concern that the £160m moneypot would not even scrape the surface, adding: “The announcement of £160m to deal with the elective backlog is welcome news, in part, but does not go far enough in addressing what will solve the issue.
“At the moment, the waiting list in England is about five million, with just under 1.8 million people waiting over the recommended 18 weeks. And this figure is growing monthly at the moment.
“Based on cost data from 2019/20, the average outpatient appointment costs an NHS trust £142 to provide.
The cash settlement will fall significantly short of what is needed to address the backlog unless there is a rapid change in the way that the services operate
“Based on this, the £160m will buy 1.1m appointments, which isn’t even the total backlog at the moment.
“And this makes the assumption that the resources - clinical staff, space, supplier and equipment - are readily available, which many will tell you is not the case, particularly staff, many of who are leaving, post-pandemic peak, either burned out or disillusioned in the way the service is managed.
“That, coupled with the doctors’ pensions issue, which is likely to come to a head in the next year, means that the cash settlement will fall significantly short of what is needed to address the backlog unless there is a rapid change in the way that the services operate; either by making use of things like AI-based triage, thinking about a non-medically-led model where appropriate, and keeping a remote element to untether the capacity to building space and enabling social distancing.”
