Turning the tide with elective care

Following on from the government’s announced focus on stemming the tide on waiting lists, many organisations including provider trusts, commissioners, consultancies and of course the public and broader political spectrum, will be thinking about how this post-Christmas miracle is going to come about.

There is evidence from home (the Tony Blair government and introduction of 18-week target underpinned by significant funding) and from abroad about how systems can make inroads into the waiting list challenge.

Here’s a summary of the key strategies:

1. Enhancing Workforce Capacity: Address shortages by expanding training, recruiting, and improving retention. This takes both time and money.
2. Elective Care Hubs: Centralise facilities for higher volume elective care to improve patient flow. This has cost implications and is sometimes less popular with the public in terms of travel and access to services.
3. Community Diagnostic Hubs: Direct referrals by GPs to bypass unnecessary specialist consultations, though this may be very challenging due to GP capacity and the implications of shifting potentially more complex care to general practice.
4. Digital Solutions: Upgrade digital infrastructure to enhance self-management, reduce missed appointments, and streamline booking and test results. This has potential benefits when the system is working well in a coordinated way.
5. ‘Cross-border’ Healthcare: Utilise healthcare capacity in nearby regions to reduce local waiting pressures. It’s a great idea but there are issues around access, travel and fragmented care.
6. Inclusive Approaches: Address health inequalities by focusing on underrepresented groups and using data to prioritise them.
7. One-Stop Shops: Establish facilities for seeing multiple specialists and conducting tests in a single visit. The system of payments doesn’t necessarily incentivise this and it requires a concerted and coordinated effort to do at scale.
8. Ring-fencing Elective Capacity: Protect elective surgery capacity from seasonal pressures to ensure consistent access to planned care. Pretty much impossible once the system is working at between 95-100% capacity.
9. Advice and guidance services: Experience of these can be variable from the excellent and timely, to poor with a consistent tangible shift of both work and responsibility of care and risks over to general practice without the matching resources needed to make this a success.

Building bridges

All of the above have significant challenges and benefits but what the system often overlooks is a systematic and resourced approach to building the bridges between primary and secondary care colleagues and turning some referrals into dialogue. This goes beyond advice and guidance which is transactional though it has its place.

Building these bridges would seem to be the best way of designing a system from end to end that works in a way that is streamlined and effective for everybody, arguably creating a safer system of care and introducing the strongest probability of a transference of knowledge and skills across the system. It is the basis of a more integrated care system and likely to be cost-effective with reduced duplication of work being an obvious example of efficiency. Patient experience would improve, and strong collaborations can create virtuous cycles of improvement in care.

A hospital department waiting list is a population in itself, with individual communities within, for example, those waiting for a particular diagnostic test or a total hip replacement or an opinion on a set of assessments and investigations. People in each waiting list community have some similar as well as individual needs. A concerted attempt at building a system that understands and responds to these needs is going to reap rewards for those people and the system that we work in. Apart from the obvious end point e.g. a hip joint replacement, we need to think about the wider holistic needs for a better outcome. These could range from prehabilitation, and an opportunity to address other needs including mental health, communication, information and anything that should be addressed to increase the chances of a better patient outcome. These could be delivered through scaled approaches including group consultations and the use of digital tools including AI.

As the system grapples with the challenge, my hope is that the leaders within it are prepared to take on the challenge of stemming the tide or collectively building a robust boat to ride the waves together to tackle what has become a perennial problem for successive governments, and all of us in primary and secondary care. It’s time to begin embracing integrated care and address the ongoing needs of the people on waiting lists living within their communities. Their own health and wellbeing and making simple things work. But perhaps in our daily conversations with our patients we simply start by talking about the power of sleeping, eating, moving and connecting?