Waiting Times...or Wasting time? A little digitisation that can help NHS service recovery.

Combining Quality and Efficiency in the NHS and Healthcare Recovery

Waiting Times...or Wasting time? A little digitisation that can help NHS service recovery.

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The COVID-19 pandemic has impacted the NHS and UK health system in previously unimagined ways.

Elective and diagnostic activities have been highly disrupted, leading to a significant backlog of patients waiting for treatment.

Many people suffering painful joint and bone conditions, ear nose and throat and ophthalmology issue and undiagnosed cancers and mental health conditions will be part of that backlog.

Capacity needs to increase considerably and be sustained. However, with the reduced availability of additional nursing staff (a problem that was simultaneously exacerbated by Brexit), that increased capacity has to come from an increase in efficiency rather than from a higher headcount.

The NHS will need a better and more informed management that enables more effective engagement between primary and community care and voluntary and private sector organisations.

It's estimated that it will take anywhere from two to five years to reduce the backlog and return services to anything resembling their pre-pandemic levels. Performance standards for waiting lists will need to be changed, as they are no longer relevant or fit for purpose. Prioritising and balancing will be the key decision-making requirements for many service and senior managers in the next three years.

Early on in the pandemic, the NHS emptied hospitals and cleared beds in preparation for the expected onslaught of pandemic patients. Similarly, the necessary increase in infection prevention and control requirements meant that efficiency was reduced, and many services stopped. Although some services were restored over the summer, the increased numbers of infections over the winter of 2020/21 meant that many non-urgent or non-emergency services were substantially reduced, or were forced to close altogether.

Professor Stephen Powis’s clinically-led review of access standards give us a valuable insight into how to improve access and how tore-think and reprioritise across the health system and it is made even more pertinent by the pandemic backlog.

It's clear that the NHS will need to manage to new standards to enable the focus on quality of care and outcomes and be ready to adapt them as the situation unfolds. These standards are all a part of the NHS Long Term Plan to improve urgent and emergency care performance and to reduce provider waiting lists over five years.

Waiting lists had already grown to 4.3 million in the three years prior to the pandemic - a rise of almost a million - and by December 2020, the official number was 4.5 million. However, there were almost 6 million fewer referral-to-treatment pathways in 2020 compared to 2019, indicating the number of people that are yet to join the official waiting list.

NHS England's monthly figures for December 2020 show over 224,000 people waiting for over a year for treatment, compared to 1,500 a year ago, and a realistic growth in forecast RTT could easily see the backlog rising to six or seven million during 2021.

However, with NHS staff exhausted and in dire need of recuperation, we cannot expect them to be able to stretch even further again to meet that huge new demand, or to endure more overtime and weekend working in order to close the gap in capacity.

Making the situation more transparent would help a great deal, as the public needs to see the reality that Trusts are facing and how much they're actually delivering. That will help encourage their continued support and help them understand the enormity of the workload that the health service is tackling, and it would be more helpful than the hoped-for, political message that things have simply ‘returned to normal’.

By taking a more joined-up system approach and using real-time data to achieve a better single picture of the truth, Trusts can have clinically led discussions on resource prioritisation in primary and secondary care. In order to keep work flowing through acute community and social services, they'll also need effective discharge and capacity information, improving flow and efficiency as a means of improving capacity.

Trusts will need to be able to quickly reconfigure and repurpose locations to accommodate "hot" and "cold" sites, separating urgent from planned care, designate COVID-19 and non-COVID-19 sites and deal with infection prevention and control appropriately in each. They'll need to be able to adapt and change at pace in order to respond to the ebb and flow of patient demand and throughput capacity across all Trusts and pathways - all of which means that they'll need better governance and compliance systems if they're to ensure quality and safety in such a rapidly changing situation.

More rapid procurement and expenditure approvals need to be the norm during this period, without the cumbersome and drawn-out processes that hamper efficiency improvement instead of helping it.

Relentless attention to safety and quality will be essential. Securing the assurance of clinical quality and patient safety will demand better levels of organisational governance with an integrated view of quality and capacity to balance throughput demands and achieve efficiency improvements safely.

It still takes too much time to produce, modify and manage plans, regulations, standards and assurance. What local leaders need is a less resource-intensive way to ensure that quality and safety aren't being compromised in those services where performance and efficiency are improving, enabling them to manage the complex task of balancing risk and opportunity at each Trust, division and service level.

By making quality, governance risk and performance more digital, and making the board assurance framework work responsively in real-time, Trusts can improve their management capabilities and more clearly see where service demand, capacity and quality are aligned or out of balance. In addition, they can reduce the amount of resources spent on laborious administrative paperwork and spend those man-hours on productive caring and capacity-delivering work instead.

NHSE&I recommends that 5% of a Trust's expenditure be spent on IT, compared to an average of 2% in practice. Digital transformation needs to encompass quality assessment, performance and risk, and provide assurance that what needs to be done is being done in order to improve the administration of governance and assurance - even if it isn't as high-profile as EPR, AI or tele-diagnostics.

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About the Author

Robert Hobbs

Robert Hobbs

As our Chief Executive and Founder, Robert has been the visionary leading InPhase to be one of the UK's leading providers of business management, governance and assurance solutions, and helping organisations align their actions and goals more easily and efficiently with InPhase's suite of integrated apps.

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