Commitment, energy and enthusiasm

The Director of the national Elective Care Transformation Programme explains how better elective care is improving people’s lives:

When people think of the NHS, what often comes to mind is ambulances screeching along streets, teams of surgeons on standby, the triumph of lives saved against all the odds.

Planned care can be equally life-saving, if usually less dramatic, and its impact on people’s wellbeing and quality of life is potentially life-changing.

However, what’s not always realised is how it also helps to reduce the strain on emergency services. Back pain, headache, breathing problems, persistent urinary tract infections, gallstones: if patients see the right person, in the right place, first time, they are much less likely to end up in A&E.

For instance, practical solutions to help people get the right care faster developed by local teams with our support include:

  • a new approach for patients with gallstones in need of urgent surgery in West Essex and Hertfordshire, reserving vacant operating slots for them so they know they will get their operation within eight days. Average A&E attendances dropped from 1.3 per patient to less than 1.0, and bed days from 5.5 to 1.5.
  • a booklet to help women under 45 in West Suffolk manage recurrent urinary tract infections. One said: “At last something to help me!” Another added: “I literally cried with relief when I read the booklet.” If they get an infection, they can hand in a urine sample and checklist to their GP practice and pick up antibiotics the same day.
  • a community migraine clinic in Salford, run by a specialist nurse, where people can get more in-depth consultations and advice than available from their GPs. Previously more than 120 people were attending the local A&E at least twice a year for headache, and more than 1,500 a year were attending at least once.

You can read about these and more in the 14 handbooks – one for each elective care specialty we’ve worked with – on our web pages.

We’re proud to have worked directly with more than 60 teams to help them create joined-up elective care tailored to people’s needs. Since our programme started its work in spring 2017, GP referrals for surgery and other planned treatments have dropped by up to 3% as patients have accessed support elsewhere.

Now we’re focusing on transforming outpatient appointments, starting with ophthalmology services.

In 2018, we responded to findings that some people were at risk of sight loss because of delayed eye appointments by developing a High Impact Intervention for both hospital trusts and their commissioners.

Fifteen months later, every hospital eye service in England has acted to ensure patients at greatest risk of losing their sight are top of the list for appointments with ophthalmology specialists, while local clinical commissioning groups have evaluated growing demand and what services will be needed to meet it.

This is part of our EyesWise project, to save sight and improve lives, in collaboration with the Royal College of Ophthalmologists and NHS programme Getting It Right First Time. The other elements of EyesWise are:

  • support for teams in Southampton, Kettering, Central Middlesex Hospital, and Brighton and Hove to set up virtual clinics for ophthalmology.
  • work with Greater Manchester which is developing its own solutions, based on local need.
  • 100 Voices, a major patient engagement initiative, to gather people’s stories of using outpatient hospital eye services since April 2018, and share them with those who plan, pay for and provide their services. This will help them celebrate success and put patient experience right at the heart of service redesign.

One thing we’ve found in our work with different areas, different specialties and different teams, is that the key to successful transformation is a whole system approach.

When GPs and practice teams, other services in the community, medical, nursing and other staff from hospital trusts, patient representatives and commissioners work together to pinpoint their local issues, develop solutions, and implement them, it is amazing how speedily things can get done. In many cases, transformation pioneered in one patch is adopted by the whole of their local system.

But we don’t want the spread of learning to stop there. We have established the Elective Care Community of Practice: a national resource offering virtual support, knowledge and expertise to everyone working to improve elective care, wherever they are in the country.

In our virtual development collaboratives, those who have pioneered transformation of elective care support others who need some assistance, and everyone is welcome to learn from them. They are a way of bringing best practice and experienced colleagues within easy reach. People collaborate, learn from putting their own solutions into action, and then share what they have learned, creating a virtuous circle of quality improvement.

We’re tapping into the enthusiasm, energy and commitment that also underpins the development of much closer working envisaged in the NHS Long Term Plan. We’re helping to build the future NHS.

If you are working on elective care transformation, you can get access to a wealth of best practice, knowledge, expertise and documents to support delivery by becoming part of the Elective Care Community of Practice, which encourages collaboration across the country and hosts the Elective Care Virtual Development Collaboratives. To join, email

Dr Linda Charles-Ozuzu

Linda Charles-Ozuzu is NHS England’s Director of Commissioning in the North West.

She was previously NHS England’s Director of the Elective Care Transformation Programme, and Assistant Director/Associate Medical Director in NHS England Midlands and East.

Her other senior healthcare management roles include extending the Department of Health’s Improving Access to Psychological Therapies (IAPT) Programme to people with long term conditions, severe mental illness and medically unexplained symptoms.

Linda is a member of the Royal Society for Public Health; a recipient of the NHS Leadership Academy Award in Executive Healthcare Leadership and an alumnus of the Global Health Leadership Forum.