The road to (elective) recovery…

The first two years of the COVID-19 pandemic wreaked havoc on many people’s lives, and we are all incredibly grateful for the continued dedication of our doctors, nurses, health workers, and volunteers in providing life-saving care for patients with COVID-19. However, whilst huge numbers were receiving urgent, life-saving care through the national emergency, it was inevitable, and in common with health systems around the world, that the amount of planned care the NHS has been able to provide would be impacted, and many patients have faced longer waits for the tests and treatments they needed to live as well as possible.

Figures from March 2022 tell us that there are over six million people waiting for elective care, of whom 310,813 will be waiting for one year, and 20,065 for two years. Such long waits are relatively unprecedented – and the statistics only tell half the story. The toll on people’s physical and mental health already is, and will no doubt continue to be, immense. People’s lives will be put on hold, and many will be forced to live in chronic pain or with decreased mobility as their condition deteriorates. That, in turn, will impact their psychological wellbeing, as well as their ability to work and care for children or relatives..

During National Voices’ meeting with Amanda Pritchard in Autumn 2021, we were pleased to hear Amanda reiterate NHS England’s commitment to keeping patients at the heart of the debate. Our interviews with people with a range of physical and mental health conditions who were at various points in the waiting and self-management journey, highlighted issues around communication, receipt of referral, contact with health and care teams, estimations around length of wait, updates on delays, access to support and self-management. For more of our insights, please refer to our Patient: Noun, Adjective report and Timely access to care: Principles for recovery. We also recognised our unique position to help bring together Voluntary, Community and Social Enterprise (VCSE) insights with NHS colleagues, to highlight what people say helps them while they wait, and how those of us leading, designing and delivering health and care services could respond to those needs.

Before Christmas, we convened a roundtable of 14 National Voices members and NHSE colleagues, led by Stella Vig, National Clinical Director for Elective Care, and Alf Collins, Clinical Director for Personalised Care Group. We engaged in rich discussion, highlighting the need for: better communication with patients while they’re waiting for care; an accessible digital platform sharing information about waiting times and providing advice for people to manage better while waiting for care; referrals from primary to secondary care clearly identifying patients’ accessibility needs (eg. language/translation, cognitive impairments); support with pain management without impacting people’s position on the waiting list; and more focus on improving access for non-English speaking patients and other often marginalised population groups. National Voices, and our members, also highlighted the need for improved signposting to VCSE non-clinical support initiatives, and for NHSE to commit to working closely with us on specific access and support needs.

We are glad to see the Delivery plan for tackling the COVID-19 backlog of elective care’s commitment to:

1. Increasing health service capacity through the expansion and separation of elective and diagnostic service capacity.
2. Prioritising diagnosis and treatment, including a return towards delivery of the six-week diagnostic standard and reducing the maximum length of time that patients wait for elective care and treatment.
3. Transforming the way NHSE provides elective care, for example, by reforming the way we deliver outpatient appointments, making it more flexible for patients and driven by a focus on clinical risk and need, and increasing activity through dedicated and protected surgical hubs.
4. Providing better information and support to patients, supported by better data and information to help inform patient decisions, and in time, making greater use of the NHS App to better manage appointments, bookings and sharing information.

The Plan sets out the NHS’ ambition to deliver nine million more tests and checks per year by 2025. This would mean that over a three-year period, patients will be offered around 17 million more diagnostic tests – an increase in capacity of a quarter compared with the three years prior to the pandemic.

This expansion in diagnostic capacity would see 95% of patients receiving a test within six weeks of referral, and no patient waiting more than a year for elective surgery by March 2025.

To reach these targets, more than 100 diagnostic centres will be rolled out, and more surgical hubs, focusing on high-volume routine surgery so more patients can get seen more quickly, will be added to the network of 122 already operating across the country.

When this plan was launched last month, its direction of travel had strong support from across the health and care sector. It is now up to the NHS, to work together with its partners to ensure that the plan’s blueprint of measures make the biggest difference for patients. National Voices and NHSE are committed to continue working together on boosting capacity and giving power to patients.

Partnership working will be particularly important to ensure the My Planned Care platform, which has been built with patient groups, is further expanded in the coming months to include personalised information and support to patients stay well while they wait, including advice on how best to manage symptoms. This platform must also be complemented by support for people who are digitally excluded, with the continued involvement of the Voluntary and Community Sector.

As the NHS’ clinical lead, Stella Vig told us that while it is for the NHS to outline how services are designed and delivered, it is only through partnership working with organisations like National Voices, that delivery can be personalised to local communities. Together we can identify the difference good communication, signposting and non-clinical support is making, and we can continue to improve by acting on these insights. For National Voices we will continue to emphasise the need to build an inclusive and person-centred recovery.

We have now identified and set principles of success – active listening and the development of trust – that will underpin the transformation that will need to be made in partnership with patients and service users. We will continue to work closely with Stella, Alf and the NHS team to ensure that new service models, such as diagnostic and treatment hubs, are fully accessible and inclusive. The millions of people in need of care expect nothing less.