Elective recovery plan: what you need to know

Overview

The elective recovery plan sets out a vision for how the NHS will recover and expand elective services over the next three years. The main ambitions of the plan are as follows:

• Waits over two years to be eliminated by July 2022.
• Waits over 18 months to be eliminated by April 2023.
• Waits over a year to be eliminated by 2025.
• At least 75 per cent of patients who have been urgently referred by their GP for suspected cancer are diagnosed or have cancer ruled out within 28 days by March 2024.

The number of people waiting over 62 days from an urgent referral should return to pre-pandemic levels by March 2023.

How the ambitions will be delivered

Increasing capacity

• Recruiting an additional 10,000 more international nurses; 5,000 more health care support workers and 17,0000 NHS reservists
• Using digital technology and data to free up surgical time to deliver more care in people’s homes
• Making effective use of the independent sector by offering patients choice of treatment and choice of provider. A new national network for long waiters will be set up and managed by NHS England which will give all regions options for treatment alternatives which will include NHS or NHS-funded independent sector care. Targeted support will be offered to local areas with specific challenges, with a new approach designed and implemented by the end of March 2022.

Clinical prioritisation

• Waiting lists are to be prioritised by those with greatest need and systems will be expected to analyse their waiting list data according to health inequality outcomes and characteristics including age, deprivation, ethnicity and by specialty. A framework and guidance to support the review of patients waiting for an outpatient appointment is due by March 2022.

 Transforming care

• Expanding community diagnostic centres (CDC) in local accessible sites where a range of tests can be carried out on the same visit. Expect to have at least 100 CDCs by the end of the next three years to increase testing capacity.
• Creating a clear separation between the urgent and elective care pathways by having surgical hubs. These hubs in standalone sites will free up capacity and provide high-volume, low-complexity surgery. 

Better information for patients

• Delivering a new platform through My Planned Care to increase transparency in waiting times and provide support for patients, eventually moving to the NHS App.
• Supporting patients to move to patient-initiated follow ups and to prepare for surgery.
• Providers will be required to adopt two-stage shared decision-making across all their admitted non-day case pathways by April 2023, and all admitted pathways by April 2024.

Analysis

We recognise that NHS staff have been working flat out to provide urgent frontline care not only throughout the pandemic, but also in the context of extraordinary demand this winter, while at the same time making in-roads into the elective backlog. Therefore, we welcome that the targets described in the plan strike a balance between realistic and stretching ambitions. We also welcome the intention to build on good practice, including record levels of cancer referrals and just over 2 million first consultant appointments from GP urgent referrals in the first six months of 2021/22, up by a third versus the same period in 2020/21.

The plan specifies the deadline for eliminating waits of over two years as July this year, allowing the service time to deliver the care. It is a significant ask, with our analysis estimating that over 96,000 patients will need to be treated before then to meet the target. The task is more straightforward for some regions and organisations than others, which have much larger backlogs to reduce. For instance, we know that over half of long waiters are concentrated in a handful of trusts.

It is right that the plan dedicates a section to backlogs in cancer care.  More analysis of the current situation for cancer, including insight from members, is available in our new briefing, The War on Cancer: What You Need to Know.

These changes will ameliorate some of the pressures, but in the longer term we know the NHS requires a fully costed workforce strategy to address the capacity challenges

The plan sets out ambitions to recruit thousands more staff and introduce technology to improve inefficiency. These changes will ameliorate some of the pressures, but in the longer term we know the NHS requires a fully costed workforce strategy to address the capacity challenges, including the almost 100,000 vacancies.

Beyond the numbers, there is evidence to suggest that many of those waiting or yet to come forward for treatment are from deprived and underserved communities ¹ . We welcome the focus in the plan on clinical prioritisation, particularly addressing health inequalities and reducing the health impact of social deprivation being fully supported and encouraged. We see the empowerment of local leaders to make local decisions based on clinical need as central to addressing the backlog in a fairer way that does not worsen health inequalities for those most at risk, who may have been less likely to seek care during the pandemic.

The planned expansion of CDCs in local sites embedded in communities is also a positive move and echoes an approach to integrating health services into local high streets that we, and our members, have long advocated. Experience has shown that treatment at home, via the expansion of virtual and digital care, or closer to home such as surgical hubs addresses patient choice, accessibility and wider system working as health and social mobility work together.

We welcome the ambition to give patients more agency in managing their health and care through more information on their waiting times and support preparing for surgery. However, talking to members from across the system, further consideration must be given to how this will be delivered by out-of-hospital services.

Without a full system approach, including plans for social care and primary care, it will not be possible for trusts alone to be responsible for reducing the backlog

Primary care has seen rising demand and managing COVID-19 cases in the community as well as high demand for appointments as patients come forward for referrals. Without a full system approach, including plans for social care and primary care, it will not be possible for trusts alone to be responsible for reducing the backlog.

There is also a growing backlog for mental health services due to the pandemic which needs to be addressed. Around 1.6 million people are on waiting lists for specialist mental health services, and an additional 8 million people who would benefit from support. While there is additional funding for mental health attached to the NHS Long Term Plan, it does not account for recent additional pressures. To begin to address the mental health backlog, a commitment to additional long-term funding is required.

Overall, the elective recovery plan set out for the NHS is broadly in line with NHS expectations, but some questions remain. As this leader summarises:

“I think the targets set are sensible. There are risks around delivery especially workforce which remains the biggest challenge There will be revenue implications of schemes vs capital monies which continues to be a challenge. Use of digital around pre-operative medicine, consent and patient engagement overall is welcome and heading in right direction.”

The successful implementation of this plan will depend on wider circumstances than just NHS teams and funding. It will rest on how a range of recent developing legislation, including the integration white paper, and wider ambitions on areas such as cancer, are carried forward and the speed at which we emerge from the pandemic.

How we will be supporting members

The plan promises to follow up with further detail on a few key areas, including a framework and guidance to support the review of patients waiting for an outpatient appointment, a new national network for long waiters will be set up and managed by NHS England and a new approach to target support for local areas with specific challenges by the end of March 2022. The NHS Confederation will monitor progress and flag the publication of further guidance or support.

We will continue to engage via our cross-system networks on the impact of this plan and next steps. Should you wish to share any comments or concerns around the plan directly with us, then please contact Rezina Hakim our senior policy adviser.