The NHS has coped admirably during the winter of 2020 to restore and recover elective services at pace, arguably faster and better than many in and outside of the NHS expected, after the impact of the first wave of the covid-19 pandemic in 2020. Further waves of infection and covid variants have led to more disruption to elective services in early 2021, with waiting lists for elective surgery growing across the NHS and the number of people waiting over a year for hospital treatment is at its highest level since 2008.
So, what’s the solution? Since the 2018 white paper No hospital is an island, important strides have been made in acute care collaboration through the adoption of group models and chains in the NHS. However, the tangible benefits of these can be slow to mobilise, even with significant investment in rebuilding culture, governance and operational processes.
Elective Care Hubs enable trusts to deliver benefits at pace but with less upfront investment required. By combining resources to deliver elective activity within a health system or geography, the utilisation of resources such as theatre space, bed capacity, equipment and staffing can be maximised, as can the ability to treat patients in date or priority order.
Moving rapidly to a collaborative structure through Elective Care Hubs is complex. Managing and coordinating elective activity with other trusts will necessitate a different approach, prioritising working as a partnership instead of in isolation to enhance system-wide patient outcomes, sometimes at the expense of individual trust targets and priorities.
There are three key pillars that must be in place to enable rapid and successful collaboration across elective services:
Planning: This is vital for any successful elective programme. In our experience, high performing trusts have well established systems for timetabling lists, scheduling patients (maximising throughput and booking in priority order), ordering equipment and managing staffing rosters. They also recognise that sharing and adopting best practice across these areas and between specialities is essential to maximise the utilisation of their operating theatres and resources.
Within an Elective Care Hub, embedding robust planning methodologies and processes will be crucial in managing the potentially conflicting needs of multiple organisations across a wider cohort of patients.
For example, balancing the pace of elective recovery alongside the broader requirements of patient demand, priority and urgency is a complex task. Therefore, careful scheduling of how resources are allocated according to system-wide capacity and demand, with robust change control processes, will be essential to maximise the value of an elective care hub for both patients and organisations.
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Commitment: All parties will need to work in partnership, agree system-wide priorities and break down organisational boundaries to collaborate effectively and prioritise patient outcomes. In particular, financial incentives and payment mechanisms will need to be considered to ensure that a trust’s finances are not detrimentally affected in both the short term and longer term. The management of competing priorities amongst partners will require clearly established objectives, aligned financial incentives, shared risk and issue management, and reporting against key KPIs.
Creating the right culture and environment for organisations to be upfront about their individual needs and when these are not being met is also an important consideration in developing a sustainable Elective Care Hub. A robust governance and communications structure is required to provide the foundation for maintaining engagement and effectively managing risk. This must extend beyond senior teams to the clinical and operational staff of the partnering organisations. Doing this will help maintain the morale, direction and commitment of the workforce providing and organising services for patients.
Insight: Accurate, up-to-date and accessible data is vital in ensuring that both strategic and operational plans are delivered and can be adapted against a continually evolving landscape of capacity and demand. The adoption of technology to share and manage information virtually such as staffing rosters, theatre timetables and the booking of patients to theatre lists will enable teams to work effectively on activities that have historically been managed through face-to-face interactions.
In the wake of the covid-19 pandemic, Elective Care Hubs will be vital in enabling NHS organisations and systems to recover their elective programme. If the NHS is to balance recovery at pace with the competing demands of safely managing the long-terms effects of covid-19 on emergency care, Elective Care Hubs are no longer a task for the future – they are needed now. However, these hubs will add an additional layer of complexity to an already complicated process.
The three pillars of planning, commitment and insight are the foundations of establishing Elective Care Hubs and transforming elective services to support a more positive human future for patients in 2021.