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Webinar 1: Delivering the elective care recovery plan 

In the first of this series of webinars, we explored the requirements of the Elective Recovery Plan – which was published in February - and the role that digital innovations can play in tackling long waiting lists and ensuring patients are prioritised by clinical need.

We startarted by hearing from Sir Jim Mackey, chief executive, Northumbria Healthcare Trust and national director for elective care recovery about the broad direction of the plan and its key asks of NHS organisations.

Then we looked at the role that digital innovations can play in supporting patients and clinicians and heard from some examples where this has been put into practice.

Speakers included:

• Sir James Mackey, national director of elective recovery and chief executive, Northumbria Healthcare Foundation Trust
• Dr Tara Sood, emergency medicine consultant, Royal Free London Foundation Trust
• Dr Arrash Yassaee, clinical director, Huma
• Viki Jenkins, heart failure advanced nurse practitioner and echocardiographer, Betsi Cadwaladr University Health Board
• James Illman, Bureau chief, HSJ (webinar chair)

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Webinar 2: How can the NHS move from waiting lists to preparation lists – and, in so doing, support more effective management of the backlog?

The backlog is such that providing good care is now, in many instances, about appropriately supporting patients who are waiting far longer than anyone would like.

Traditionally, being on a waiting list has involved just that – waiting. But there is now an onus on NHS organisations, underscored in the elective care recovery plan, to move to a process of engagement during this period.

Indeed, doing so will be important to the effective management of the care backlog. Communicating with patients regularly, checking on their symptoms and determining whether they still need to be on a waiting list, will improve not only patient experience but also system efficiency. It will also be part of supporting existing concepts like patient-initiated follow up.

So how can the NHS create this shift? How can we create not waiting lists but preparation lists? How can digital technology play a part? What are the obstacles that need to be overcome along the way?

Speakers included:

• Jugdeep Dhesi, consultant geriatrician, Guy’s and St Thomas’ Foundation Trust and deputy director, Centre for Perioperative Care
• John Eaglesham, chief executive, ADI Health
• Layla McCay, director of policy, NHS Confederation
• Dileep Lobo, professor of gastrointestinal surgery, Nottingham Digestive Diseases Centre

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Webinar 3: Can addressing the backlog be a means of addressing health inequalities?

A constant process of clinical prioritisation to determine which patients should be seen in which order in seen as central to effectively managing the backlog – but could it also be a means of addressing the longstanding health inequalities so starkly highlighted by the pandemic?

Social and demographic factors may not have traditionally been considered when making decisions about how soon a patient should be seen. Yet with waits now so long for so many people, some argue they now consistently should be. Should the single parent kept from an already-low paying job be a higher priority for care than the parent kept from a high paying job who has a partner still in employment?

Should, in short, social and demographic factors come into play when the NHS is defining clinical need in the context of the backlog? And, if so, what does that mean for how we clinically reprioritise patients? What data we will need to make assessments? And what of the issue of finding patients whose care should be a priority on this basis but who are not even on the waiting list?

Speakers included:

• Jim Forrer, clinical lead, Optum and practising GP
• Kiran Patel, consultant cardiologist and chief medical officer, University Hospitals Coventry and Warwickshire Trust
• Jonathan Pearson-Stuttard, chair of health inequalities programme board, Northumbria Healthcare NHS Foundation Trust; head of health analytics, Lane Clark & Peacock; chair elect, Royal Society of Public Health
• Mary Hill, head of policy – national healthcare inequalities improvement programme, NHS England
• Sarah Scobie, deputy director of research, Nuffield Trust

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Webinar 4: Restoring eye care services to reduce avoidable sight loss  

Nearly 600,000 people were waiting for ophthalmology treatments in January this year: the largest waiting list of all NHS specialties and nearly 10 per cent of all of those on the referral-to-treatment pathway.

The pandemic has obviously contributed to these numbers and there is general acceptance that a different approach to that adopted in the past will be needed to tackle waiting lists. Ophthalmology was already one of the specialties targeted in the national outpatient transformation programme, which pre-dated the pandemic, and some areas have already introduced technological innovations, revised pathways and new ways of working.

Yet more progress will be needed if patients are to avoid sight loss and impaired vision which can have a profound impact on their daily life and leave them more dependent on others. At the moment, one person gets a diagnosis of sight loss every six minutes in the UK.

Although glaucoma and cataracts attract most attention, the range of sight problems is much wider with age-related macular degeneration, for example, affecting 1.5m in the UK.

In this session we explored what the NHS can do to ensure that this backlog of patients is treated and that a sustainable service is established for the future.

We asked:

• What are the opportunities for changes in clinical practice what could start to address the backlog? Within ophthalmology, which conditions offer the greatest opportunity to increase capacity utilizing the existing workforce and reducing the burden on hospital services?
• What learning has there been during the pandemic and which areas have managed to improve services during it? Why has there been so much variation across the country with some areas seeing very large increases in waiting lists and others very small ones?
•  Going forward, what will a sustainable eye care service look like and what key steps can managers and clinicians take to move to it? What difference could integrated care systems make?

Speakers included:

• Robert Cooper, RNIB strategic engagement lead - NHS
• Conn O’Neill, public affairs partner Roche
• Professor Bernard Chang, president of the Royal College of Ophthalmologists
• Dr Alison Davis, medical director of Medway Foundation Trust, joint clinical lead GIRFT ophthalmology report
• Dr John Bhargana, consultant ophthalmologist at the Countess of Chester Trust, joint clinical lead GIRFT ophthalmology report
   

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Webinar 5: How to improve patient flow through supported discharge 

Freeing up space in hospitals is a key consideration for all trusts as they try to increase the amount of elective patients they can admit, in line with the elective care recovery plan.

It is well-documented that hospitals have struggled to discharge patients who no longer need medical or nursing care but whom do require domiciliary care or a place in a residential home. Even where trusts have worked closely with councils, these delays have persisted.

But are there other patients who could be discharged to their own home with nursing and allied health professional support? Obviously community healthcare teams would potentially be involved in the care of some of these patients but may not have the capacity to cope with all of them.:

• What patients might be suitable for early discharge if the right package of nursing and AHP support were available to be delivered in their own home?
• How can they be managed in a way which minimises clinical risk and integrates with hospital teams, while offering patients the chance to return home earlier – or even not to come into hospital at all?
• What is the role of technology in supporting care at home for this group?
• As integrated care systems take over from clinical commissioning groups, are there opportunities to address some of these issues over a wider footprint?

Speakers included:

• Helen Buckingham, director of strategy, Nuffield Trust
•  Matthew Winn, chief executive, Cambridgeshire Community Services Trust and director of community health, NHS England
• Jill Ireland, CEO and clinical director, HomeLink Healthcare

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