Covid-19 Elective Guidance Issue 7: July 16th 2020

System Leadership Memo: “Dear Chief Executive”

The resumption of elective services nationally is an urgent priority. Variation exists between local organisations, systems and regions in terms of their readiness. A national framework that can easily be understood, implemented and monitored at pace would provide organisations with clarity, a methodology to follow and reduced variation / equity for patients across the country. Given the need to move quickly, we recognise that we are not operating in a perfect world. Data systems and staffing levels mean that we will have to work with what we have got for now, with a plan in place to improve it over time.

In an ideal world we would be able to clinically review all elective patients and risk stratify them into different groups that required different actions. However, most organisations do not hold all their elective patients on one list. Additionally, there has been huge variability in how the elective lists have been reviewed during lockdown due to staff availability. It is within this context that we have created a robust and pragmatic methodology for moving forward at pace. The methodology has 3 distinct phases:

• Establishing the baseline: how much variation exists? Where are the biggest areas of concern?

• Recovery Planning: given staff, estate and PPE requirements this planning increasingly needs to be done at a regional level so that resources can be pooled and risk shared.

• Execution: some organisations will find it more difficult than others. Targeted support and interventions should be in place where necessary.

At a national level, these phases need to be underpinned by technology to track and monitor progress, improvement teams to help where needed and potentially rapid data cleansing in the most challenged areas.

Priority groups of patients need to be identified across all the 5 main waiting lists that exist. During lockdown we would expect Trusts to have carried out data cleansing and clinical reviews of some or all of these patient groups.

It is unlikely that non-RTT follow-ups and diagnostic PTLs have been reviewed to the same extent as the nationally reported lists (Cancer & RTT). Clinicians have also expressed concern about patients on the planned waiting list.

Given the priority on pace, we therefore believe the system should focus on 3 priority areas:

1. Cancer PTL

2. RTT Long-Waits

3. Planned patients past due date

Once these cohorts have been baselined it might then be possible to move onto Non-RTT Follow-ups and diagnostic PTLs over the medium term. A timeline for the 3 phases is detailed below: