Karina Malhotra, founder and MD, Acumentice, explores how technology is being used to solve the elective care conundrum and to what extent emerging tech can make a credible difference on the front line
There is reason for cautious optimism in healthcare and, indeed, society in general when it comes to COVID. The vaccine programme is going better than anybody hoped – both in viral reduction and roll-out and uptake speed – cases and deaths are receding and, as a result, so is the pressure on the NHS.
However, there is a chord of caution to be sounded around the state of healthcare once the smoke clears on this pandemic. It comes after the NHS Confederation recently warned the prime minister that healthcare unrelated to coronavirus will most likely not resume at the speed it did last year due to the harsh impact of the second wave. Nowhere is this more pertinent than in the area of NHS elective care in the acute sector. NHS England data published last month shows 4.46 million people were waiting for routine operations like joint replacements or cataract surgery in England by December. Of them, almost 200,000 had been on the list for more than a year, the highest number since records began in 2007 and 140 times more than in 2019. Little surprise then that there are calls for the Chancellor to increase investment in health and social care in next month’s budget.
A new approach is required
While extended waiting times have sometimes been pitched as a problem created by COVID, that is only partially true. Even before the pandemic, there were around 4.4m people on the NHS waiting list and although the majority – around 80% – of patients were waiting less than the 18-week constitutional standard, it has been considerably short of the 92% target set by the government for some time. We saw a decline in waiting list sizes during the summer of 2020 due to demand somewhat being suppressed as a result of the pandemic – however, as this has returned to pre-pandemic levels, so has the waiting list size – only with significantly longer waits where only c68% are waiting less than 18 weeks.
There are many factors at play driving this, from extreme seasonal cycles of weather to Brexit, but while the pandemic exacerbated historical issues, it also underlined that the NHS can respond quickly to an unprecedented crisis. It isn’t static, as is the widely-held perception.
The answer to the inadequate capacity issue has, historically, been to increase efficiency and throughput – more people treated in a smaller space and in shorter times. Of course, in a world of social distancing and infection prevention and control, we’re now doing exactly the opposite. This, combined with the fact that existing metrics and processes for monitoring elective care performance may no longer be fit for purpose means a new approach is required.
Maximum value for patients
Reverting to type is not an option and both clinicians and healthcare providers must find ways of treating those patients at most risk of harm in sufficient numbers to make a difference without simply working down a checklist to hit a target. It would mean not trying to meet the needs of a generic population within a given time period but instead, matching the individual patient need against a population-driven set of clinical priorities.
Critical to the success of this approach will be to engage clinicians in what has traditionally been perceived to be an administrative function. Some clinicians may have been involved in waiting list management certainly for urgent care but for the majority, this became relegated to an administrative function to do with waiting times rather than individual needs based on clinical priority. We have to be focusing on using our limited resources for the maximum value for those individual patients and a more clinically driven approach to doing that will be the most effective way to manage a growing waiting list.
Innovation through technology
Thankfully, the NHS has proven itself to be an incredible innovator. We’ve seen more collaboration and adoption of new tools and technologies this year than ever before. That said, one area that remains ripe for disruption isn’t the waiting list process itself, but the quality of data on it. These lists contain thousands of records and if some of those are inaccurate or no longer awaiting treatment, it places much greater significance on the coveted appointment slots for the patients that genuinely need them.
However, unlike sweeping changes to attitudes and the core process of prioritising patients, improving data quality by using digital tools such that the manual work is reduced is far more straightforward. There are many examples where this is happening already. For instance, Imperial is using a ‘smart’ software to automate data quality correction and validation saving 35,000 manual hours of work annually. Clinicians can decide what’s important for their patients, and how long they should wait whilst addressing any inaccurate waiting list entries of patients not requiring treatment, leading to a 10% to 15% improvement in waiting list data quality as a result.
Innovations through technology are key because losing patients in the system or increasing the number of incorrect entries on the waiting list is a scenario nobody wants. The balancing item is ensuring we have full-scale engagement with the patients – the people who ultimately pay for and are the beneficiaries of the services that we provide.
Capitalising on the reset opportunity
There is no doubt COVID has brought major challenges to the NHS but it has simultaneously exposed valuable learnings and it is critical we use the reset opportunity that has been given to us.
It is clear that change is needed and we have to do things more efficiently, more effectively and more innovatively because even if we combine capacity in the NHS and independent sector, we still don’t have the capacity to achieve the current targets.