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A lot of people are increasingly waking up to the fact that elective services will shortly have to resume across the NHS. But there are some observations we have that are not being discussed or planned for and we think they need to be: 1/13
We have noticed a drive from the centre and regulators to treat the resumption of elective treatments like they would have treated an organisation not meeting its targets - to ask for recovery plans coupled with detailed trajectories of when the backlog will be cleared. 2/13
This is lazy thinking in our view – the elective landscape has totally changed and strategies for returning to normal need to account for these changes, specifically: 3/13
Clinical practice and attitudes to following people up have shifted. The paternalistic practices of following everyone up endlessly have shifted towards paternalism meaning it’s better to not see them if at all possible. 4/13
Reinforcing this further is the fact that patients now often don’t want to be seen – particular in a hospital setting. This not only has profound meaning for follow-ups but probably even more significantly, diagnostics. 5/13
What does this mean for the resumption of electives? First thing is that waiting list information was already wildly inaccurate pre-pandemic. ONS estimated it was incorrect by circa 40%, which is amazing given how much faith in this as the source of recovery plans. 6/13
In addition, the new model in which clinicians and patients want to see less, rather than more patients means there are a huge number of patients on the already flawed waiting lists that could safely be removed. 7/13
So, the first step is to re-baseline how many patients need to be seen under the new operating conditions. This will require a large scale cleaning of the waiting lists in consultation with primary & secondary clinicians as well as large scale patient engagement. 8/13
Next commissioning. For 10 years or more we discussed integrated care & shifting hospital based care into community and primary care. Surely now the time to execute this? Area of focus should be diagnostics – many if not most of them do not need to be in a hospital setting. 9/13
A shift in emphasis away from hospitals is not only needed but perhaps for the first time, demanded by patients and clinicians alike. It is an indictment of the system that this it has taken a crisis like this to actually implement the very things we have known for years. 10/13
And technology. It simply isn’t good enough. Hospital administration systems do not handle waiting lists well and the refusal of their corporate owners to open them up to new technologies is a national disgrace. 11/13
Community technology a cottage industry & whilst primary care probably the most advanced it has never been opened up to proper scrutiny either. Even the NHS’s own electronic referral system doesn’t have an API to integrate with other platforms. The whole thing is a tragedy. 12/13
Most importantly, we return to our first point: lazy thinking. We need fresh ideas, leadership & people who can actually implement rather than commentate. We have a once in a generation opportunity to change elective services for the better – we really shouldn’t waste it. 13/13
