NHS publishes electives recovery plan to boost capacity and give power to patients

The NHS and government have today set out a blueprint to address backlogs built up during the COVID pandemic and tackle long waits for care with a massive expansion in capacity for tests, checks and treatments.

NHS chief executive Amanda Pritchard and Health and Social Care Secretary Sajid Javid announced that the health service will build dozens more community diagnostic centres as part of the new elective care recovery plan.

The ‘Delivery plan for tackling the COVID-19 backlog of elective care’ will also give patients greater control over their own health and offer greater choice of where to get care if they are waiting too long for treatment.

Teams of specialists will be deployed to help patients prepare for their op, and groups of clinicians and teams will be able to get instant access to test results, offering patients faster clinical advice.

The NHS has also said it will increase capacity to deliver more procedures and scans in each of the next three years, to around nine million more tests and checks by 2025.

This will mean that over a three-year period, patients will be offered around 17 million more diagnostic tests – an increase in capacity of a quarter compared with the three years prior to the pandemic.

More than 100 diagnostic centres will also be rolled out, with the increase in capacity coming on the back of the NHS accelerating the rollout of these ‘one stop shops’ over the last year, with 66 set to be in use across England by the end of March – 26 more than previously planned.

New surgical hubs will also be added to the network of 122 already operating across the country, helping ensure that unless people chose to postpone, the longest time patients could wait will reduce so that by March 2025 patients aren’t waiting longer than a year for surgery.

The hubs focus on high-volume routine surgery so more patients can get seen more quickly, making efficient use of taxpayer resources, and creating extra capacity so emergency cases do not disrupt operations and cause cancellations or delays.

The plan, developed with Royal Colleges, patient groups and health charities, sets out how the NHS staff will make the best use of additional government funding to begin to address the COVID backlog.

NHS staff have been working hard to recover services while dealing with the rise of Omicron and sustained numbers of COVID hospitalisations, high levels of staff absence due to COVID, all while accelerating the booster rollout with more than eleven million boosters delivered since December 12.

The plan will ensure that the innovations put in place by local areas can be expanded, and comes as the NHS has already committed to continuing to increase investment in mental health services through the mental health investment standard as well as providing further funding for primary and community care services.

NHS chief executive Amanda Pritchard said: “As we move out of the Omicron wave the NHS is applying the same determination and ‘can do’ spirit we have displayed throughout the pandemic, to address backlogs in routine care that have inevitably built up, and reduce long waits.

“That cannot happen overnight but we are determined to make the best possible use of the additional investment and take the best from our pandemic response, including smarter use of digital care and flexible working between teams and trusts, while building this additional diagnostic capacity that will help to accelerate progress.

“As we have always said throughout the pandemic, it is vitally important that anybody who has health needs continues to come forward, so that staff can help you with the best options for your care”.

Prime Minister, Boris Johnson said: “The NHS is there for us all in our time of need, but the pandemic has put unprecedented strain on health workers and patients alike.

“Today we have launched the biggest catch-up programme in the history of the health service backed by unprecedented funding.

“These measures will make sure patients receive the right care, in the right place at the right time as we bust the COVID backlogs and recover from the pandemic.”

Health and Social Care Secretary Sajid Javid said: “Just as we came together to tackle the virus, now we must come together in a new national mission to fight what the virus has brought with it.

“We are absolutely committed to tackling the COVID backlog and building a health and social care system for the long term.

“Our COVID Backlog Recovery Plan will help the NHS reduce waiting times, give patients more control over their care, and harness innovative technology to free up staff time so they can care for more people up and down the country can get the treatment they need.

“This is a vital step in radically rethinking how our health service delivers operations, treatment and checks as we look beyond the pandemic and learn to live with COVID-19”.

Alongside existing clinical standards for urgent and emergency care, mental health, cancer and planned care, the NHS will deliver on:

  • Eliminating waits of longer than a year for elective care by March 2025
  • By July 2022, no one will wait longer than two years for an elective treatment
  • The NHS will aim to eliminate waits of over 18 months by April 2023.
  • Three quarters of patients who have been urgently referred by their GP for suspected cancer will be diagnosed, or have cancer ruled out within 28 days.
  • Returning the number of people waiting more than 62 days from an urgent referral back to pre-pandemic levels by March 2023.
  • Deliver around 30% more elective activity by 2024/25 than before the pandemic, after accounting for the impact of an improved care offer.

Despite the NHS treating over 600,000 patients with COVID, staff have also cared for at least two people with other conditions for every patient with the virus, throughout the pandemic.

The continued rollout of the diagnostic centres in convenient places including retail parks and shopping centres will make it easier for patients to get tests closer to home and reduce the number of visits by delivering multiple tests in a single appointment.

Expansion in diagnostic capacity will mean 95% of patients receive a test within six weeks of referral.

The increase in capacity will help the NHS towards achieving its target, set out in NHS annual planning guidance in December 2021, of returning the number of people waiting more than two months for cancer care to pre-pandemic levels.

The NHS is already one of the most efficient health services in the world, spending 2p in the pound on administration, compared to 5p in Germany and 6p in France.

NHS England is determined to get maximum patient benefit out of the extra investment and is expanding capacity and investing in additional space locally as part of a £700 million scheme, to speed up the recovery of elective services.

The money will go to more than 180 NHS trusts, split between 870 different schemes including installing modular operating theatres and expanding mobile diagnostic centres for cancer.

Among the schemes to receive the funding is a number of surgical hubs in Cheshire and Merseyside, four operating theatres in Hull and repurposing of outpatient sites in Bedford, to increase capacity.

While a record number of doctors and nurses are currently working in the NHS, the plan recognises that further work is needed to train, recruit and retain staff – and that delivering elective recovery will require not just more new staff, but more opportunities for current staff and those returning to practice to work flexibly and remotely, and to develop new skills to progress in their careers.

The plan will see the NHS transform patients’ experience, putting people in control of their own health giving them the right to swap to a different provider if they are waiting too long, providing a more personalised service and freeing up appointments for those who need them.

A new My Planned Care digital service to be launched later this year will tell patients when they should expect treatment and signpost them to support that can help them while they wait.

While instead of hospital administrators automatically scheduling follow-up appointments, doctors will talk to patients about whether and when it will most benefit them to be seen again, with patients able to rebook or cancel if they change their mind or if their health needs change, so minimising disruption to a patient’s daily life while freeing up clinicians’ time for new patients and those with the greatest clinical need.

Learning the lessons of the successful NHS pandemic response, particularly the COVID-19 vaccination programme, the NHS will use digital tools and data to drive the delivery of services to manage waiting lists more efficiently.

Chelsea and Westminster Hospital have centralised their waiting list across surgical specialities helping cut cancellations by 80%, while a smarter approach to ophthalmology tests at Moorfields has reduced patient consultation times from several hours to 40 minutes, and in Bristol, NHS teams have made use of their ‘Joint School’ app which is used by people waiting for hip and knee surgery, to prepare for their treatment.

While pathologists will be able to instantaneously share diagnostic scans including ultrasounds, x-rays and MRI’s with expert clinicians so patients get access to specialist advice immediately.

Professor Helen Stokes-Lampard, Chair of the Academy of Medical Royal Colleges said: “With the NHS under so much pressure it’s absolutely right that we take steps to ensure patients are able to get the treatment they need. This plan very clearly sets out what we need to do in the months and years ahead and although it may seem radical in parts, is nevertheless essential  if we are to reduce the backlog in elective care and ensure that those who are most sick are prioritised. By setting out in clear terms what patients can expect from the NHS and how they in turn can help, I hope it will also take some of the pressure off our hard-pressed health and care staff who are facing the most extraordinary workload and stress day-in, day-out”.

Matthew Taylor, chief executive of the NHS Confederation said: “Health leaders will welcome the national commitment to tackle the backlog of elective care. The NHS is working hard to prioritise patients with the greatest clinical need, including by carrying out 1.3m consultant-led treatments in a single month and we have seen some brilliant examples of innovation where data and technology have been used to both support patients and ramp up activity. While the NHS will continue to do everything it can, at least six million people are known to be on the waiting list and so, we need continued honesty about the scale of this challenge, particularly as coronavirus has not disappeared”.

Professor Neil Mortensen, President of the Royal College of Surgeons of England said: “The Elective Recovery Plan recognises that the NHS needs more surgical capacity – more operating theatres and more beds. Crucially, it supports our College’s recommendation to establish surgical hubs across the country, where planned operations are protected from winter pressures and outbreaks of COVID-19.  Surgical teams like our colleagues in Barking have shown tremendous commitment and creativity during the pandemic, adopting new ways of working and collaborating across hospitals to re-design surgical services. This plan recognises that we need to support and spread these innovations, and also invest in making surgical services more sustainable in the years ahead”.

Neil Tester, Director of The Richmond Group of national health and care charities said: “Tackling waiting lists quickly and well is a top priority for patients and the public, so it must be central for the NHS. An end to the physical and mental pain so many people suffer while waiting for treatment can’t come too soon, so it’s good to see this recovery plan identifying ways to speed up treatment at the same time as supporting and updating people while they wait. Making sure people get the right rehabilitation and aftercare will be vital too. Our member charities are committed to working with the NHS and care services to help get that support to people who need it, to making sure national and local decision-makers understand how the changes are affecting people’s experiences, and to helping these initiatives focus on tackling inequality”.

Rachel Power, Chief Executive of the Patients Association said: “We welcome the publication of this plan and look forward to working with NHS England on its implementation.  We also welcome NHS England’s commitment to work in partnership with patients to improve their experience of waiting for care and treatment, and how it communicates with patients waiting for care. This is something we have been calling on the NHS to do since the start of the pandemic. Today’s commitment meets many of our requests for how patients waiting for care, who are often in pain and discomfort, are told how long they will have to wait, are kept updated, and where and who from they can get the support and advice needed to keep themselves healthy while they wait. We hope that communication will be delivered in formats that suit individual patients, as not everybody has access to digital technology or knows how to use it. It is critical that as the NHS tackles the enormous backlog in care, it does not inadvertently increase health inequalities the pandemic has highlighted, by providing information and support that is not accessible to patients living disadvantaged lives.”

Jacob Lant, Head of Policy, Public Affairs and Research at Healthwatch England said: “With six million people now waiting for treatment, this plan is very much needed. Given the scale of the backlog, most people understand that their treatment may be delayed. But while they wait, people want support if they need it, and to know that the NHS has not forgotten them.

“It’s great to see the NHS acting on the issues people have raised with us. If this plan is successful, it should make waiting more bearable, with improved access to help like pain relief, clearer communication about when patients can expect treatment and the ability to tell the NHS about changes in their condition”.

Dr Charlotte Augst, Chief Executive of National Voices, said: “Timely access to services is now the main concern people raise with our members, 190 charities working right across health and care. Our members and we at National Voices have worked closely with NHSE/I to ensure that people who wait can be well supported. From listening to people who wait we know that good communication, signposting and non clinical support all make a massive difference.

“We will need sustained investment in growing the workforce and overall capacity of the service to meet the health and care needs of people – but we also need to reshape how services are designed and delivered. We will work with the NHS to ensure that new service models, such as diagnostic and treatment hubs, are fully accessible and inclusive”.

Tracey Loftis, Head of Policy & Public Affairs at Versus Arthritis, said: “Long waits for treatment are having a big impact on the physical and mental health of people with arthritis. This recovery plan is urgently needed and marks an important step forward in tackling long waiting times.

“Whilst we welcome efforts to expand surgical capacity, and to give people more information, it will be crucial that people know when they will start to see the benefits.

“We want to work with the NHS and the Government to make sure the Elective Recovery Plan delivers for people with arthritis – helping to bring down waiting times for joint replacements as well as ensuring people receive effective communication and support”.