The overwhelming theme from this discussion was that effective communication within local systems will be essential to success. The national strategy has set out the ambition, but ultimately solutions will be implemented locally. Five relationships stood out as being vital.
1. Local areas and their neighbours
With integrated care systems (ICSs) now in place across the country, now is the perfect time to capitalise on integrated working. There are plenty of opportunities to create efficiencies in elective care, if organisations within ICSs are willing to try something new together. Participants shared anecdotes of how they had pooled resources over the past two years to maximise elective activity – for example by creating high-volume low-severity surgical hubs.
And because the size of the waiting list varies across the country, there are also opportunities to work across ICS boundaries. During the discussion, many reflected on their willingness to share resources with their neighbouring systems. And sharing resources includes sharing innovation – referred to by participants as 'stealing with pride'.
2. Primary and secondary care
Elective waiting lists sit awkwardly between primary and secondary care. GPs refer patients to the waiting list, but hospital trusts usually deliver the care. It would benefit everyone if the relationship between primary and secondary care was stronger.
Part of the challenge of the current situation is that the demand for elective care is increasing and there could be up to 10 million patients still missing from the waiting list in England. Effective management of demand will be vital to ensuring any reductions in the waiting list are sustainable. Participants were hopeful that this could be partially achieved through honest and open conversations between primary and secondary care about referral processes and criteria.
3. Leaders and their workforce
The existing workforce will be doing the majority of the work to tackle the elective backlog – the same workforce that has worked tirelessly through a pandemic for the past two years. New initiatives are unlikely to get far without the existing workforce being onboard. Leaders within the group reflected on their need to work with their teams to first, safeguard the wellbeing of their staff, and second to ensure their staff are working effectively. Staff should be closely involved in developing plans, as each team member will have their own priorities – for example some will prefer weekend working, others will prefer to travel outside their area for a shift at a surgical hub.
4. NHS and patients
This is likely to be a difficult relationship for local health systems to manage. There is no easy way to explain to patients that they could be waiting a year or even longer for their treatment. The main takeaway from this discussion was that health care providers were going to have to have honest and transparent conversations with their patients. First, to manage expectations and help patient to ‘wait well’. Second, to co-create or at least explain new ways of delivering care, such as virtual consultations. And third, to make sure patients still access the care that is available to them – many are worried that patients will ‘fall through the cracks’ in the system. Providers will need to make sure that they are communicating effectively with patients so that waiting for treatment is an active and informed process.
5. Local systems and their data
Not a relationship in the same sense as the others, but the relationship local systems have with data will be critical. A good grip on the waiting list data will enable local systems to dynamically prioritise their patients and to tackle the backlog ‘inclusively’, as they have been asked to do.
Counterintuitively, data can help to remind people that the waiting list is not just a number. One hospital trust shared with the group that they had already started linking the waiting list data with other data, such as levels of deprivation. This helped them identify patients at risk of the worst health outcomes because of pre-existing health inequalities. The ambition was for this to go even further to incorporate social value into the prioritisation process – for example, patients who need treatment to return to work could be moved up the list faster.
The roundtable perfectly demonstrated how useful starting a dialog is when faced with a new task. Participants openly reflected on challenges they were likely to face and shared a host of great ideas with each other. Successful management of the elective backlog will require local systems to do the same. They will need to build new relationships and strengthen their existing ones.