Covid-19 Elective Guidance Issue 3: May 18th 2020
Covid-19 Elective Guidance Issue 2: May 1st 2020
29th July 2020Covid-19 Elective Guidance Issue 4: May 26th 2020
29th July 2020Risk Stratifying Elective Care Patients: Part 2 Remedial Action on Risk Stratification
When in doubt Centralise?
The NHS has been tackling the resumption of elective work after Simon Stevens’ intervention a few weeks ago.
They have decided to manage the prioritisation at STP or ICS level.
In our last issue, we explained how organisations should approach this prioritisation based on where the most risk sits (see diagram).
We highlighted specifically 3 “blind-spots”: Follow-up, Planned and Diagnostic patients.
These are areas that have traditionally not been well managed and aren’t reported anywhere nationally. They are also the areas where most clinical risk sit as they involve patients with Long-Term Conditions and patients who are under surveillance for reoccurring cancer.
What is happening now?
Hospital Trusts have been asked to share their waiting lists centrally where either STP or ICS leaders will then decide prioritising resources. So far so good?
Well, to date the only lists that have been asked for are Cancer and RTT waiting lists. As you can see from our diagram, these are relatively easy to share and review centrally. However, there has been no mention of the 3 blind spots.
The problem, is that doing this risks missing the areas where the most clinical risk sits.
We are not aware of any instruction to start compiling lists of these patients. Why not?
What needs to change?
Priority groups of patients need to be identified across all of the 5 main waiting lists that exist.
2 of these lists (Cancer and RTT) are well known and easy to identify. The other 3 less so – urgent work should be underway now to get these in place.
A recent HSJ article estimated that patients who have waited more than a year will grow from the current 3,097 nationally to around 14,500 in the next month or so. And yet look where these patients come in our list above – Priority 3.
Some concrete examples – there are currently 678 RTT patients waiting more than a year nationally for orthopeadic surgery (the specialty with the highest numbers nationally). Whilst not to make light of that situation, it is highly unlikely anyone will come to serious harm whilst waiting for a hip replacement. On the other hand, patients who have gone past their cancer surveillance date might have had a reoccurrence which could well be life threatening.
Ophthalmology have 124 RTT patients waiting over 1 year. Are we seriously suggesting these are more urgent than say, patients on a follow-up list awaiting treatment for glaucoma or AMD at risk of going blind?
None of this is intended as criticism – managing lists centrally might well be the best way to allocate scarce resource.
The problem is that currently we are sharing the wrong lists. Urgent work is needed to identify patients at risk outside of RTT waiting lists.