Troubled ICS diverting 400 electives each week under new model

Sussex Integrated Care System told HSJ  its new elective coordination centre had radically boosted its ability to optimise its local capacity, as it had been relocating only 10-15 appointments a week before the new system went live earlier this year.

Independent experts said that while the coordination centre approach had been used elsewhere, the scale of patients being moved by the Sussex system was a lot larger than others.

They questioned whether the model could be pushed further in other systems to replicate Sussex’s returns to help better utilise elective capacity across whole systems and supported struggling trusts (see below: Reaction to the model). 

The development of this model is particularly notable because both the integrated care board and main provider University Hospitals Sussex Foundation Trust had the highest number of 65-week breaches in England as of the most recent data published last month.

The major teaching hospital has significant performance problems, as well as cultural challenges involving bullying allegations and calls for a public inquiry into a slew of serious incidents and investigations into its maternity department.

In the most recent data, for April, the ICB had 4,779 65-week breaches, of which 4,374 were at UHSFT (see tables below). Systems have been set a target to eliminate all 65-week waiters by September.

How Sussex model works

Daniel de Rozarieux, director of elective care at Sussex’s Acute Provider Collaborative, spoke to HSJ  following a presentation about the model at the HPN elective recovery seminar last month on the new model.

“Within the first two months we have demonstrated how this approach can realise true benefits for our providers, and ultimately for our patients – we are excited by the strong foundations for elective recovery which this is creating across all providers within the system,” said Mr de Rozarieux. 

He said that previously the system had sought to redirect activity by targeting patients on the admitted waiting list. 

But the coordination centre instead identifies patients referred into acute care but who have not started treatment, because patients who have not yet started their care are far more likely to choose to relocate to a different provider.

The ICB said the model has also allowed more 65-week breaches to be funnelled away from UHSx to independent providers. The system uses data which allows it to match patients with alternative providers which are as convenient as possible, and the work is paid for at standard tariff rates.

Around 3,000 patients who were due to be seen by UHSx were reallocated to alternative providers in April and May, the ICB said. It now forecasts it will be able to use the model to reallocate “thousands per month”.

Nearly a third of the 3,000 patients (980) were at risk of breaching 65 weeks by September. They were mostly sent to other private providers in Sussex, but some went to NHS and private providers in surrounding counties.

Mr de Rozarieux said 600 of the 3,000 patients in April and May were reallocated to an alternative NHS provider in Sussex, 2,200 to independent providers in Sussex, and 200 to independent providers or trusts outside the county.

UHSx managing director for planned care and cancer Huw Edwards said: “Initially this approach is providing additional choice and capacity mainly for patients at our trust, but the principle of using resources drawn from across Sussex to manage waiting times across the whole county is a really positive step, and one we hope to embed and extend as we are able to do so.”

Reaction to the model

Several leading experts told HSJ the scale being achieved in Sussex appeared more significant than comparable models, two of whom were prepared to speak publicly.

Jack Bramhall was until recently Birmingham and Solihull elective care hub’s programme lead at University Hospitals Birmingham FT and is now a senior manager at consultants Attain UK.

He told HSJ: “[The NHS] spends a lot of time hammering individual trusts on [backlogs], but taking a step back and coordinating across a patch such as this is a better use of overall resource for the patients of the system.”

He added it would have been “really challenging” to get the model working because co-ordinating so many different stakeholders’ interests’ was a difficult task.

Waiting list consultant Barry Mulholland, a partner at MBI Healthcare Technologies, said it was “fantastic” that extra capacity was being used to cut long waits.

He added: “I would query why this approach isn’t used more widely as we’ve known for years that patients are more likely to move if they haven’t already been seen by someone locally.

“One note of caution would be that I’d like to see more detail on costs – is it more expensive to treat patients in this way rather than increasing NHS capacity?”

The ICB said the system was also working on NHS improving capacity across East Sussex Hospitals and Surrey and Sussex Hospitals trusts Queen Victoria Hospital FT in addition to capacity at UHSx.

Table 1: ICBs rank on 65-week waiters - April

Table 2: Trusts ranked on most 65-week waiters - April