With a need to drive up productivity through optimising every element of the pathway, the key to a successful covid recovery plan lies in local relationships

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Two recent interventions from senior NHS voices have focused attention on the urgent need to address planned care waiting lists. Sir David Nicholson described waiting lists as “a truly frightening backlog”; asked about this comment Sir Simon Stevens said “I certainly agree that it is very important that we max out treatment capacity and we have to expand electives activity again.”

Sir Simon went on to suggest that the NHS needed to “think very innovatively, and potentially very radically, about how to redesign some of those care pathways into the health service – rather than just return to the same old ways of doing things”.

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The pandemic has shown that the NHS is able to deliver precisely this kind of radical change. Large sections of the elective pathway, and much of primary care, went virtual within weeks to respond to the needs of the pandemic. Many parts of the NHS demonstrated a capacity to deliver fundamental changes which the doomsayers said were impossible.

The challenge in the months ahead is to maintain and develop the aspects of this experience which deliver cost and quality benefits, while addressing the fact that other health needs have not been adequately addressed during the pandemic.

The period between June and November 2020 provides some clues about what is possible. NHS England guidance during this period suggested that Trusts should aim for elective surgical activity to return to pre-covid productivity levels.

Based on data available to Four Eyes from 17 NHS Trusts the reality was that between June and November average theatre utilisation reached 64 per cent of available time compared with a pre-covid utilisation of 78 per cent.

On the face of it this is a depressing statistic, but there is good news as well. The range of experience was considerable; some units were able to fully recover activity levels to pre-covid levels as a result of tight procedure planning and use of independent sector capacity, while activity in other units was severely impacted as complex perioperative infection control protocols increased downtime between cases and patient anxiety led to high cancellation rates.

The challenge now is to learn from the experience of those who achieved a full recovery in the 2020 covid recovery period and apply the lessons in 2021.

As we consider those options we also need to be clear about the constraints. There simply is not the time or money to build new capacity. Making the best use of existing staff and facilities, with consideration to collaborative working between providers, must be the first level of response. There is a need to drive up productivity through optimising every element of the pathway.

Equally, longer operating days do not necessarily translate into increased theatre capacity. Previous analysis by Four Eyes revealed that, although this approach can help when it is properly planned and agreed, it can also lead to increased downtime as well as increased cancellations and frustrated expectations.

“The key to a successful covid recovery plan therefore lies in local relationships” – according to Brian Wells, CEO of Four Eyes and former managing director of SWLEOC and Guy’s Orthopaedic and Plastic services.

“The relationship between management and clinicians is what’s going to make the difference and help the NHS find the additional capacity it requires, both transformational and through a focus of optimising every element of the elective pathway. It’s never been more critical”.

Have providers got the relationship and appetite to change the embedded cultural norms and “stand-offs” of days gone by? Is there the appetite to reset elective capacity through tackling unwarranted variation across a long list of embedded behaviours and processes?

Four Eyes’ analysis of last autumn’s elective recovery revealed excellent performance in some trusts and continuing problems in others. The key will be to ensure that the lessons of success are understood and applied.

“The NHS needs operational and clinical leaders to embrace and embed transformational change in ways never seen before” continues Mr Wells. “It won’t be easy but that doesn’t mean it isn’t necessary”.