No single solution will crack the complex challenge of the elective backlog. While even the most optimistic forecasters recognise recovery will take years, there remain a series of non-clinical considerations to benefit those waiting for treatment in the near-term, but which remain underexploited. Improved communication should be top of that list.
Patient communication is where expectations and experience of the NHS are at their greatest divergence. As part of our research, Policy Exchange commissioned Savanta to run focus groups with patients awaiting treatment over six months. All participants stated clear communication was vital to having a ‘good NHS experience’, yet the vast majority felt current communication was poor. Many felt ‘in the dark’ about their treatment, some received news of appointment cancellations at short notice, leaving them unable to effectively manage their time waiting, meaning an increased risk their condition (and mental health) would deteriorate.
These complaints are sadly commonplace. With one in 10 currently on the waiting list, we likely all know someone who can share a similar experience. To avid readers of this blog, these insights will accord with the findings of National Voices’ excellent Patient Noun, Adjective report from 2020.
While there are exceptions of good practice, the way waiting times are communicated to patients, and how individuals are supported, requires reform.
A lack of a systematic, transparent approach to patient communication has created a sense of unfairness and frustration impacting the system as a whole, where General Practice becomes a first point of contact once patients fail to reach hospital departmental staff. Failing to tackle the issue risks cementing existing inequalities if staff feel compelled to address the most persistent patients ahead of those with greatest clinical need.
It may appear counterintuitive, but fronting-up to delays and problems can build support and buy-in from the ‘consumer’. Where revalidation means a wait longer than 52 weeks, being clear and candid, yet compassionate, must become a greater priority.
There is some evidence the NHS is working to enhance its communication with patients, such as the recent publication of Good communications with patients waiting for care guidance, but best practice has not been rolled out widely. Current exemplar letters could be significantly enhanced (as we demonstrate in our report) to signpost patients toward further materials or services to manage their wait.
The NHS App in particular should be enhanced to become a front door for information and supportive services. An ‘Upcoming Treatments’ section should be added so patients can manage appointments and communicate with staff. Users should have access to a personalised ‘Preparation Plan’ (based upon location, procedure type and relevant medical circumstances) with signposting to peer support and services offered by the voluntary sector.
Better use should be made of existing waiting list data published by NHS England – bringing this into the conversation with the patient, who can be informed of the length of waits for their clinical speciality, so that they can make an informed decision about whether they may want to seek treatment at another hospital or privately.
Embedding this information within the app is only one solution. As Miles Sibley has recently written in this blog, there is much to be done to make this information more accessible and useful both to patients, GPs and to NHS staff alike, but the NHS App can be a useful tool in boosting operational transparency overall.
In his preface to our report, Sir Bruce Keogh, former NHS National Medical Director, writes that the public’s tolerance of the widespread impact to their own treatment during COVID “must be repaid”. Improved communication is a good way of delivering upon that promise.