Is NHS service redesign the key to the backlog crisis?

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Oli Hudson, content director at Wilmington Healthcare, looks at the huge challenges posed by the care backlog – and some possible solutions via GIRFT and service redesign.

The NHS backlog built up over the pandemic is possibly the biggest single issue to manage if the NHS recovery is to succeed.

And it’s not just elective care treatment that’s at stake, but an extensive healthcare ecosystem of diagnostics, reviews and other interventions, as patients have been unable to attend many NHS healthcare settings.

Wilmington Healthcare’s Quantis Covid Impact Tracker suggests that between March and May this has affected up to 5 million patients. Missed diagnoses can lead to disease

progression and complications, further adding to backlog pressures the NHS will have to face going into phase 3.

The backlog reduction will also have to take place in the context of the COVID hospital and aftercare burden of some 300,000 patients – many of whom will require acute care resource in a variety of specialties such as respiratory, renal, and physiotherapy. There will be additional constraints posed by infection control, finances that are uncertain at best, and a waiting list that was already the longest it had been for a decade.

Local systems therefore face an unprecedented challenge and solutions from medtech will have to take this background into account. In this scenario, what will be the main NHS drivers in the second half of the year that could affect product use?

Reducing complications and revisions, reducing length of stay and increasing patient throughput have long been part of a medtech value proposition, and they take on a new level of importance when dealing with a backlog of this size and complexity. However, what is just as important to understand is how the NHS itself is stratifying and prioritising patients, and how it is beginning to redesign services in the full knowledge of what is to come.

The role of GIRFT

Step forward the GIRFT (Getting It Right First Time) initiative, whose teams have tentatively begun re-entering hospitals to do deep dive work on best practice, gathering data that adds some evidence to exactly what blend of technique, product, staffing, patient engagement, pathway and resource management will best unlock the NHS’ capacity to be ‘high-flow’,  and free up staff time to get those millions of patients treated.

GIRFT is perhaps surprisingly optimistic: “We are in a strong position to help specialties refocus in the post-COVID world, where changes that did not seem possible pre-COVID now seem more achievable.”

Cataract surgery is a good example of what this will entail – and a good bellwether of how other specialties could cope, given that pre-COVID it was the most common operation. GIRFT has recently published a piece of guidance that takes in all of the above challenges, as well as the clinical, organisational and technological progress that has rapidly been made during the pandemic.

GIRFT: pathway redesign and patient flows

Crucial to understand is that GIRFT is encouraging NHS specialties to look at their pathways as something of a blank slate, ripe for service redesign.  In the case of cataract surgery, this covers the consenting process, as a discussion of COVID risk to the patient in the first instance; a transparent, consistent set of prioritisation criteria to direct care to those most in need; and a method of returning to a normal or near normal number of cases per list rapidly by using appropriate mitigation, for example, ‘COVID-19 free or light’ pathways and patient selection processes.

GIRFT looks at data to understand theatre flow, patient journey times and number of cases per list to understand where bottlenecks are occurring and what can be done to make improvements. It establishes the necessity of consistently grading patients for risk and complexity, and to interpret and benchmark this data.

One stop pre-assessment clinics can be used to minimise the number of times patients need to attend the hospital. And a joined-up service is also crucial, with pre-operative appointments linked to dates for surgery and post-operative review, along with a short timeframe, supported by telephone or video consultations.

GIRFT thinks that if measures like this are introduced wholesale, then the cataract backlog can be effectively managed.

Positioning products within new pathways

So the learning for medtech here is that they could be offering their solutions within a new pathway where:

  • the types of patients are different
  • the point at which surgery is delivered is altered
  • the location is changed to where services can cope
  • the timeframe of the pathway is reduced
  • the means of managing the patient pre- and post-operatively is different

Medtech would need to take all this into account and align value propositions with the NHS’ aims in this area.

If it takes off in cataract surgery, it is likely that the techniques will be used in other specialties. Similar measures are covered in GIRFT’s joint work on stroke with the Oxford AHSN, and medtech would be advised to keep an eye on GIRFT, its deep-dive work and the various types of guidance it will issue over the next few months.

It will also undoubtedly be useful to know the levels of capacity hospital providers are currently operating at, compared with what will be expected of them at the height of the backlog, to see how these service redesign measures will land – and which providers will need the most help from industry and in which specialties.

Wilmington Healthcare can help prepare you to better support your NHS customers: