Building back better with a new fund for elective recovery tech

I’m delighted with the news that a £250 million Elective Recovery Technology Fund has been established this year to help implement digital solutions that will make a real difference to elective recovery. This opportunity really is tremendous.

It is part of the “Targeted Investment Fund” of £700 million established as part of the government’s ‘Build Back Better Plan’ for health and social care and was announced yesterday as part of the latest NHS Planning Guidance. For more about the Elective Recovery Tech Fund see the Unified Tech Fund prospectus.

But what kind of difference could digital tools make to surgical pathways and waiting lists? Here are just a few examples of the type of progress it is possible to make when technology is at its best.

Extra bed capacity

A digitally supported virtual ward in Norwich has been described by patient Leigh Jones as “game changing”. Leigh, cared for there recently following sepsis, said he was “indebted” to the local NHS for bringing in innovative pathways so that he could leave hospital to recover from sepsis at home with his grandchildren and five cats, whilst clinicians monitored his temperature, pulse and blood pressure remotely via a strap on his arm. Since February the virtual ward has saved 2,000 bed days, providing crucial extra capacity, and clinicians believe the mental and physical benefits to patients are huge.

Most ICS (over 80%) now have a digitally supported virtual ward, some having opened very recently as part of work we are involved in to help scale this model. This funding means that they could expand further, open up to a wider range of patients, and increase their coverage, particularly over winter to enable the elective programme to continue successfully.

Saving clinical time

A major orthopaedic surgical centre in south London saves almost two hours of clinical time per patient (1.92 hours) by conducting home based pre-assessments. The clinical time saving is worth £94,000 for every 5,000 patients, and it reduces carbon emissions as it saves many trips to hospital.

Shorter stays for patients

A surgical centre in Huddersfield uses a digital device to support patients’ prehab and monitor their recovery and rehabilitation at home. Many patients having knee replacements have been able to return home that evening after a hospital stay of just 13 hours, where they are monitored remotely by community physiotherapists. Patients get feedback on whether they are doing their rehab exercises correctly and many more fully complete their rehab with this feedback.

Giving patients choice with appointments

In Nottingham, many patients choose when and if they would like to be seen by a clinician in outpatients rather than having set appointments regardless of need. This is supported by a strong communications platform so it is easy to find information and to get in touch with the clinical team. It is very highly rated by patients and means that appointments take place on the basis of need, reducing those that were adding no value by one third, freeing up space to see new patients, reducing waiting times and allowing time with those that do need clinical input.

Alternatives to waiting lists

Patients with common musculoskeletal issues, including chronic back pain, following a home-based, app-supported treatment and exercise programme (prescribed by their GP practice, first contact practitioner, minor injuries/A&E department or hospital team) were found to improve markedly with a five fold reduction in pain relief prescriptions. The improvements meant they needed fewer GP visits (-13%) or physiotherapy appointments (-20%). Patients were extremely positive with all of those surveyed feeling that the app had helped their recovery.

Making best use of theatres

Operating theatres and treatment rooms are a precious resource and therefore any cancellations on the day are a great shame, as at that point the time cannot be used for another elective patient. In Urology around 8% of patients having a cystoscopy have to be cancelled on the day as they are found to have a urinary tract infection. Home based testing ahead of surgery using the patient’s smartphone to read urine dipsticks could reduce that by at least half, something that a large surgical hospital in Cambridge is trialing.

Pinch with pride

There are many more great examples across the country and the Elective Recovery Tech Fund gives the opportunity for trusts, primary care providers and ICSs to “pinch with pride” and fund their own programmes with the same benefits for patients and staff. There are a host of further case studies in our Digital Playbooks and four focus on high volume elective specialties - Musculoskeletal health, Eye care, Gastroenterology and Dermatology.

The use of the fund is being overseen by regional teams in partnership with NHSX. If you would like guidance on putting cases together please see the Unified Tech Fund prospectus. Information can be found in the “Elective Recovery Tech Fund” section.

We have also set up a small Elective Recovery Tech Fund taskforce, please contact us at dnhsx@nhsx.nhs.uk with any query you may have.

Further information

The categories supported by the Elective Care Recovery Fund are:

• Evidenced digital solutions that support people at home on alternative care pathways such as establishing digital offers for those patients in need of support with their mental health or pain management avoiding the need for hospital based care.
• Digital tools that help with active waiting and self management including supporting increased activity, weight loss and smoking cessation.
• Home based pre-surgical support including virtual surgery schools, patient information packages, digital pre-assessment, digitally enabled preoperative rehabilitation and consenting.
• Digital tools and operational data that support the deployment of enhanced recovery after surgery approach, leading to improved patient outcomes, faster patient recovery, shorter patient stays and reduced post surgical complications.
• Patient facing tools for communication, including patient held records that enable patients to select when/if they want a follow-up appointment (digitally-enabled personalised follow-up), staff to provide guided self-management, and asynchronous clinical triage supported by a patient self-assessment.
• Deployment of robotic process automation to reduce the administrative burden on staff and improve the efficiency of clinical processes.
• Real time operational data or population health management tools that help systems to visualise performance to best balance capacity and demand, reducing waiting times as rapidly as possible.
• Use of digital innovations that support early discharge and home rehabilitation, including virtual wards and remote monitoring licences.
• Other digital tools that present a clear benefit to productivity or access to health care, such as ENT devices and ophthalmology image sharing solutions

See also the NHS H2 operational planning guidance.