The COVID-19 pandemic saw access to elective care reduce dramatically, and waiting lists grow. The reduced access was worse for some. While inequalities have been a longstanding challenge for the NHS, in many cases, pre-existing inequalities in access, experience and outcomes were further exacerbated by the pandemic.
To support elective care recovery, the 21/22 NHS Operational Planning Guidance laid out five priority areas for the NHS to focus its’ operational efforts on, one of which was to “restore elective care inclusively”. Systems were encouraged to use their local data to identify, improve understanding of, and take action to address healthcare inequalities.
As a result of the operational planning guidance, examples of interventions and programmes aimed at delivering inclusive elective care recovery began to emerge. The Healthcare Inequalities Improvement Team at NHS England asked the Strategy Unit to collect and collate some of these examples in a structured way.
In February-April 2023, we spoke to operational and clinical colleagues involved in interventions aimed at delivering inclusive elective care recovery across England. These case studies present accounts of what we heard.
Sheffield Children’s artificial intelligence (AI) tool predicts a child’s risk of not being brought to their outpatient appointment. Use of this tool has allowed the service improvement and outpatient teams to target support to families at most risk of not being able to attend.
The Midlands Partnership University NHS Foundation Trust’s Community Dental Service provides the general anaesthetic service to vulnerable children and young people (CYP) in Staffordshire and Stoke on Trent. The service’s waiting list increased four-fold due to the disruption in service caused by the COVID-19 pandemic. To support equitable recovery, the team used a clinical prioritisation tool to identify and prioritise treatment for CYP most in need. As part of their efforts to clear the backlog, the team focused on identifying and implementing changes that might improve the service’s efficiency. The team were able to reduce the service’s waiting list to below pre-pandemic levels.
As part of a wider programme of work designed to improve equity within services, Barts Health NHS Trust’s Addressing Inequalities in Care Programme team commissioned the development of data tools which identified a significant difference in surgical wait times for patients with learning disabilities than those without. By exploring the data further, and collaborating with colleagues from across the Trust, the team was able to reduce waiting times by over 100 days.
Royal Free London developed and piloted an approach to reduce missed appointments and increase the proportion of patients with ethnicity recorded. There was evidence that the intervention could successfully reduce missed appointments and increase recording of ethnicity data.
Set for Surgery is a prehab intervention for patients awaiting elective surgery. Its aim is to support patients to optimise their health and to improve both individual outcomes and surgical pathway efficiency. The intervention was piloted in winter 20/21, targeting patients from more deprived neighbourhoods with known health risks. Pilot study findings included improvements in the health status of participants and a reduction in on the day cancellations.
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