Some steps are being taken to address the situation. In the recently released NHS planning guidance for the year ahead, accelerating the restoration of elective care is a core priority: in the words of the national health service, to achieve their goals, they must “do things differently”.
NHS funding has been directed into local systems to attempt to reduce surgical waiting lists, in the form of the Elective Recovery Fund. At HomeLink Healthcare, we agree that things can and should be done differently – and we believe we can utilise our experience and skill sets to deliver services that will ease the backlog challenge, make most effective use of inpatient beds, minimise inpatient stays and promote flow. Facilitating transition towards new approaches to tackle surgical backlog within the healthcare service.
As the BMJ puts it, “waiting lists” must be transformed into “preparation lists”: the time between diagnosis and surgery could be harnessed to get patients prepared for surgery, improving patient experiences and outcomes, hospital flow, and reducing the costs of healthcare. It’s exactly this that we believe should be adopted – and that we have the capacity, skills and workforce to deliver.
By using our services for a different part of the patient’s journey, we can help patients get fit for surgery by utilising a range of prehabilitation methods. Generally, this would mean working on enhancing patients’ mobility and general health status. For orthopaedic patients, that would mean pre-surgery physiotherapy to improve agility and mobility, working with breathing exercises to limit the risk of chest infections post-op, and working towards improvements in nutrition. We can also offer pre-op screening – where we visit the home to check the well-being and health perspective of a patient before the trip to the hospital. Monitoring vital signs, observing mobility, checking the general health condition to ensure they are well enough for surgery.
Pre-pandemic, this was usually done in the hospital or within community provisions, but both have been stretched to their limits. In some parts of the country, no community prehabilitation is currently available at all. Regardless, prehabilitation was something primarily for those undertaking radical surgery, and there is a body of evidence that demonstrates it is highly beneficial for all pre-op patients.
Prehabilitation has been shown to reduce postoperative complications by 30-80%, and reduce hospital stays by one or two days. Other studies illustrate reductions in postoperation mortality. If all patients had access to a degree of presurgery optimisation, people would recover better and leave hospital earlier – alleviating both hospital capacities and surgical waiting lists.
Virtual ward and early supported discharge are services we have been honing and delivering for many years at HomeLink Healthcare. We have multiple successful, harmonious partnerships with NHS Trusts in the UK where we create added capacity by freeing up space in the hospital. In terms of the elective backlog challenge, this equates to more space in hospitals for other patients to get in and have their operations.
Once patients have had surgery, we support them to come home sooner than they normally would and continue to deliver safe care in their homes. How do we do this? Under our Discharge to Assess service, we identify patients that are medically fit to leave hospital, speed up their transition home and undertake their assessments and package of care there. With our Virtual Wards, patients remain under the care of both the hospital consultant and members of our team, while receiving a wraparound of home-based care from our experts.
This method is not only possible but effective – and is one we are already delivering across the country. In one of our co-created programmes,
There is a wealth of evidence that demonstrates a patient can safely return home three days or even 24 hours after an operation. The only issue is that the community capacity is not in place to facilitate it.
The problems are well-documented. There are solutions and the evidence to support them. Covid-19 illustrated how rapidly practices and behaviours can change on a wide-scale. Now that the virus is slowly being wrangled back under control, healthcare should not retreat to past practices, but embrace the new ways of working and the light that has been shone on what needs to be done differently.
How can my Trust or health system find out how much could be gained by the adoption of these pre and post-surgery practices? HomeLink Healthcare will provide a free assessment of your organisation’s ability to improve patient flow through prehabilitation and Virtual Ward/Early Supported Discharge, based on real world experience in the NHS. To find out how to get started please click here to get in touch with us today.
“I am so grateful to have been referred to HomeLink Healthcare, they have really helped me get back on my feet. If I had stayed in the hospital I would not have achieved everything I have done”
“The visiting therapist took her time with me, was always providing encouragement and without that I wouldn’t be at the point I am today.”
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