For the latest edition of the HTN special report series, we’re exploring how the elective care backlog can be tackled, with input from Alcidion and Open Medical.
CQC recently noted that the waiting list for planned elective NHS treatment has more than doubled since the start of the pandemic. In light of this, a series of initiatives underpinned by technology have been introduced across health and care to tackle the elective care backlog.
Recently the Department of Health and Social Care launched a Taskforce in the area, following previous methodology from its COVID-19 Taskforce. For patients, they now have access to information on procedures and advice while they wait through the My Planned Care website. Community diagnostic centres, new pathways, understanding data at a service, organisation and regional level, and waitlist validation are some of the programmes helping to tackle the backlog.
NHS England published guidance in December to support healthcare systems with validating waitlists, and shared a number of targets leading up to May 2023. The targets indicate how validation should proceed, from approaching patients with a waiting time of over 52 weeks in January to targeting patients with a 12-week wait from May. HTN covered the letter from Paul Doyle, national programme director for elective recovery at NHS England, here.
In this special report, Alcidion shares a thought leadership piece on how the elective list can be tackled, whilst Open Medical presents a case study on their surgical pathway management platform, designed to allow theatres to operate at full capacity.
Alcidion on tackling the backlog
Demand for hospital treatment was outstripping capacity even before the pandemic, so it was inevitable that the demands of delivering care during COVID-19, intensified by winter viruses, colds, and Strep-A, plus emergency department pressures, have led to significant backlogs and longer waits for patients. According to the BMA, waiting lists for consultant-led elective care grew from 4.24 million in March 2020 to a record high 7.21 million in October 2022.
The £500 million winter fund to increase bed capacity and provide more support in the community will provide little comfort to critically understaffed teams if they cannot access the information they need to provide optimal care and accelerate patient discharge for the patients they look currently care for.
So, what can the NHS do to alleviate the problem right now?
Unifying data to improve patient flow
Bringing together data from multiple systems, such as the PAS, EPMA, inpatient digital systems, pathology and reablement services using an open-standards data platform means clinicians can access the full picture of care for the patient, supporting quicker decisions from admission to discharge and beyond. A single, consolidated view of the patient within a real-time command and control platform ensures each patient is quickly and safely moved through their care pathway, freeing up beds for future hospital patients, including elective care patients who need hospital support.
Critically, when this is assessed at a service or organisational level, it creates the understanding of where the bottlenecks are and how they can be resolved.
This approach does not involve ripping out and replacing entire IT systems, instead making the most of existing technology and unlocking value from existing solutions. Deployment of smart technology to create a longitudinal record means routine activity is automated with information and actions promoted along the pathway, reducing the cognitive burden on staff.
Visualisation of the entire care pathway
The NHS needs to use the data from incumbent systems in a more flexible way. By consolidating the data in a longitudinal view, clinicians can see exactly what is required to move a patient to the next stage with automated alerts replacing manual processes. With real-time capacity and demand visualised across the entire system, teams become more agile, filling resource gaps which supports safer, quicker discharge for patients into social or community settings.
Replicating the care experience at home
New and emerging models of care are being adopted, including virtual wards and care. By using smart technology to replicate the patient experience at home, beds can be freed up more easily whilst still maintaining clinical oversight. Our experience as the technology enabler for Sydney (SLHD) shows the impact that can be made when technology solves these challenges. 80 per cent of virtual care patients said they felt confident at home knowing their symptoms were monitored daily and 89 per cent said the technologies used improved their access to care and treatment.
Intelligently matching capacity with demand
Effective waiting list management for planned and unplanned care removes a huge administrative burden on acute, community and social teams, freeing up hundreds of hours of clinical time and improving staff satisfaction.
Flexibility of cloud-based solutions
Deploying system-wide cloud-based services removes the walls between care settings and gives system leaders the ability to quickly set up surgical hubs and diagnostic centres to alleviate some of the current pressure on hospitals.
Making the most of available technology
Alcidion is helping health and social care organisations across the UK, Australia and New Zealand make the most of the technology they already have installed. Bringing the data together enables effective decision making at the point of care, freeing up valuable time for clinicians. With virtual care and flow modules, patients are cared for in the most appropriate setting, freeing up critical space for more hospital-based elective care procedures.
Open Medical on optimising surgical hubs by harnessing the power of digital solutions
In October 2022, 7.21 million were waiting for their elective surgery. A frightening figure that confirms the severity of the situation and its urgent needs. As a response, surgical hubs were established as centres dedicated to elective care in order to maximise operational capacity and reduce the elective backlog. Stand-alone hubs are a model of surgical hubs that are entirely separate sites dedicated solely for elective care. Once established, stand-alone hubs need to factor in various aspects and transform their processes so they can successfully address the growing elective waiting lists.
The hubs will receive patients from multiple organisations within the region. This means that multidisciplinary teams will need full visibility of the most up-to-date scheduled theatre lists with all pertinent patient information. Digital solutions can provide the necessary infrastructure to bring about efficient elective centres.
Pathpoint SurgiCare – Open Medical’s cloud-based, end-to-end surgical pathway management platform – can provide stand-alone hubs with real-time overview of all hub activity. SurgiCare offers full visibility of digital theatre lists, filtered waiting lists, patient status and tags, preoperative assessments (POA), patient consent, risk stratification, equipment request, and clinical notes, all of which are automated and tailored to the surgical hub’s unique requirements. SurgiCare truly encompasses a holistic view of the entire patient journey.
This allows theatres to operate at their maximum capacity, effectively allocating resources and minimising delays, cancellations, and underbooked operating rooms. Additionally, with access to all the necessary information, including patient tags, patients can be identified when they are not fit to be operated on within the hub. This information can then be communicated via SurgiCare to ensure patients are operated on at the appropriate site. Surgical hub staff can save valuable time and relieve the administrative burden, allowing them to spend more time on delivering high-quality patient care.
As a cloud-based platform, SurgiCare transcends organisational boundaries; it is accessible from anywhere, at any time, with tiered user permissions, enabling vital information to be shared while adhering to governance regulations. It facilitates effective cross-site and cross-team communication between surgical hubs and organisations, allowing all relevant teams to track patients along their elective surgical pathways. Importantly, SurgiCare captures granular, coded clinical data that can be utilised meaningfully for future service planning, providing the relevant information for additional efficiency improvements. SurgiCare can serve as the unified portal for all surgical hub activity.
Elective centres can flourish given the right tools, and adopting digital solutions such as SurgiCare can help maintain and increase capacity, support staff, and enhance patient care, effectively reducing the mounting elective waiting lists. Surgical hubs and SurgiCare were both created to address the elective backlog, and when used in tandem, they can revolutionise elective care delivery.
HTN on ICS initiatives, waitlist validation, care collaboration and patient communication
There are lots of projects and programmes across the NHS aiming to tackle this issue. We are hearing about numerous different initiatives to tackle the rising numbers – waitlist validation is one such example, with patients being asked to confirm whether they still require their place on the list as time passes.
On the topic of waitlist validation, last month HTN heard from James Rawlinson, CIO at South Yorkshire and Bassetlaw ICS and Director of Informatics at The Rotherham NHS Foundation Trust, and Helen Williams, Transformation Lead at Royal Cornwall Hospitals NHS Trust.
James and Helen shared the work they have been doing in this area from their trusts; Helen described how her trust has implemented Netcall’s Patient Hub which features a waiting list validation module. Towards the end of last year, they moved on to progress waitlist validation through three speciality pathways – neurology, orthopaedics and cardiology – to check that patients on their outpatient waiting list who had waited past the 40 weeks stage still required an appointment.
“Our highest response rate was from orthopaedics where we had nine percent of patients removed,” Helen said, “then it went to neurology with seven percent and six percent for cardiology.” She added that they saw a “very quick response” from the digital validation, with 63 percent of patients coming back to confirm that they wished to proceed. “I’d say we had actually had a higher response rate than we would have done if we had actually sent out paper versions…. we were surprised by the speed of the turnaround.”
James explained how his trust’s strategy, planning and development teams collaborated with service managers and Sheffield Children’s Hospital to look particularly at follow-up patients as well as neurology and dermatology patient lists at the 40 week mark.
Looking to the future of waitlist validation for his trust, James said: “It’s about scaling now. We also want to look at sharing approaches and methodologies across the ICS. If you’re a member of the public living within our ICS area, you might get different organisations contacting you, but if we’re all following the same wording and processes that will help to strengthen that single NHS message.
We’ve got lots of people using different platforms such as the NHS App, so in the future I’d want to look at how to leverage some of that national capability. That would mean that members of the public can use the tool that they’re used to, whatever it is.”
Other examples across health and care include the launch of Community Diagnostic Hubs, enabling new pathways to take some of the pressure away from hospitals; and the government’s new Elective Recovery Taskforce, which brings together a range of healthcare experts in the hopes of helping the NHS deliver on its waiting list targets.
At Northamptonshire ICS, the Integrated Care Northamptonshire Elective Care Collaboration has been developed; an initiative which aims to bring together the organisations involved in planning care in order to utilise a patient-centred approach to improve health. The collaboration will see transformation in service delivery with focus on supporting patients to keep well at home or close to where they live. As part of this, the organisations are working together as a system to manage waiting times for their population by investing in digital through the national NHS Targeted Investment Fund. So far, this has led to the development of an outpatient management system, increased digital patient communication, a waiting list management tool and digital platforms for patient consent and pre-operative assessment.
Meanwhile, at Newcastle upon Tyne Hospitals NHS Foundation Trust, two new initiatives have been introduced to tackle the backlogs: a new ambulatory care unit in which patient care pathways have been designed to reduce inpatient bed delays and unplanned admissions, and a remote system designed to monitor treatment delivery in real time.
Finally, NHS England has shared guidance, ‘Good communications with patients waiting for care’, to highlight core principles to help deliver personalised, patient-centred communications to patients who are waiting for care.