Philip Purdy, senior consultant, Acumentice, explains why he feels healthcare needs a new model to meet Phase III targets and maximise its window of opportunity for recovery before winter.
In the last few months, the NHS has achieved things that would have previously taken two to three years. It’s been a tremendous effort, and all focused on the facilitation of safe and continuous healthcare provision within the context of a pandemic.
Now, as the EPRR incident level moves to a regional focus, NHS Trusts are faced with not only the continued pressures of COVID-19, but also meeting the activity targets outlined in the Phase Three letter. Additionally, Trusts know they only have a small window of opportunity before winter hits with its associated seasonal viruses and challenges.
Then there’s the demands of elective care. With waiting lists already at an all-time high pre-pandemic, Trusts are braced for an onslaught as they attempt to rearrange postponed procedures while accommodating new referrals. All while putting patient safety first and foremost, irrespective of new ways of working. So how best to resume elective care during an in the aftermath of the Coronavirus? Certainly, demand and capacity planning will be crucial to manage the pace of recovery. Visibility of how many new patients are being referred, how many patients are waiting, and their acuity will be key to enabling such planning.
New ways of working for new eras
It would be a mistake for organisations to assume that the ways of working that were used before the pandemic are all that is required afterwards. As the third objective of the Phase Three letter highlights, dealing with the pandemic has created significant learning opportunities and new best practices which NHS Trusts and other providers now need to integrate into their operating procedures. It also highlighted that, the NHS can move, and change, at speed.
While operating in a pandemic-level state of change is not sustainable long term, Trusts need to be looking at how the innovations they implemented in the early stages of the pandemic can be embedded into a new model that ensures they can effectively tackle their Phase Three objectives.
What does that look like? In short, it is digitally enabled, agile and built around the restrictions imposed by the COVID-19 response (such as limiting face-to-face contact and reduced physical capacity onsite).
Not all of this is new – a lot of the trends and tools, such as remote consultations, telemedicine, better use of data, have been on the digital agenda for the past couple of years. The urgency of the pandemic, and now the same need for pace to seize the window of opportunity, has simply accelerated the implementation of many of these concepts.
A new approach to capacity and demand planning
Consider capacity and demand planning. Demand as a concept needs reimagining to ensure that patient safety is the guiding principle when managing elective care with the limited resources available. It is no longer about the patients waiting on known lists or indeed how long they have waited. Rather, considerations will need to be finessed to include individual patient clinical priorities, the backlog of deferred patients and a potential build-up of delayed referrals from primary care.
How capacity is defined is likely to need rethinking too. Historically, modelling determined the number of additional slots that would be needed to meet demand, which in turn were associated with physical estate and clinically staffed hours jointly. In the coming months it is vital that Trusts are able to understand much more explicitly if capacity shortfalls are estate related, staff related or both.
We’re entering a world in which capacity will be increasingly shared, not only between Trust sites, but between private and public provider locations as well. It also needs to effectively integrate virtual or remote capacity.
A further challenge is that, until now, all demand and capacity planning models have been based on historical data. With the pandemic upending any sense of planning based on past performance, there needs to be a shift towards more predictive modelling based on accurate, real-time data. It will be necessary to model a range of possible scenarios, including a second wave necessitating another suspension of elective activity. To do that effectively will require expertise in harnessing both data and operational intelligence.
Digital tools will be essential if this expertise is to be harnessed effectively and at pace to provide reliable models. Platforms which allow a collaborative operational approach and data sharing among teams across pathways, organisations or care systems are important here.
Ensuring accurate, quality data
This leads to a demand for quality data. Getting accurate information on referral to treatment times involves multiple individuals and pieces of software, in turn providing myriad opportunities for errors to creep in.
It is important, therefore, to check in with local operational and information teams to assess and review the data quality on waiting lists, as well as commence demand and capacity scenario modelling. These teams will require effective recovery tools, skills and capacity to conduct a more holistic recovery of elective care.
Putting patient safety first and foremost with new ways of working
Individual Trusts will need to find the approaches that work best internally and within their own integrated care systems. Each system should look to develop a plan which is embedded in an accurate and evolving understanding of the capacity and demand locally – while keeping patient safety at the forefront.
What is beyond doubt is that, as elective care recommences, all trusts need to do everything they can to maximise the window of opportunity before winter pressures arrive. It is only through expert use of data and digital tools, and avoiding slipping back into unsuccessful ways of working, that this will be achieved.
