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Why recognising the resourcefulness of patients is key to overcoming the surgical backlog

By 
 – 
November 20, 2021

The collective effort of healthcare and essential services staff to guide us through this pandemic has been truly inspiring and remarkable. But as the dust begins to settle and the economy starts to spring back into action, it is becoming increasingly clear that the impact of the pandemic is likely to be felt for many years to come.

Few areas of the NHS have been as drastically impacted as elective surgery provision.  Waiting lists for surgery in England currently stand at around 5.3 million, an increase of 900,000 since the pandemic began.

Worryingly though, it has been suggested that we may just be seeing the tip of the iceberg. A report published by the Institute of Fiscal Studies (IFS) last month pointed out that between March 2020 and May 2021 there were 7.4 million fewer people joining the waiting list than would have been expected according to pre-pandemic patterns. 

Now, as the NHS begins to open its doors again to routine care, it is likely that we are going to see a surge in referrals for elective surgical care, and with that a record rise in waiting list numbers. The IFS predicts that numbers may even reach as high as 14 million by the autumn of 2022.

The surgical backlog in numbers:

  • 5.3 million currently on the waiting list in England, 9% of England’s adult population
  • Over 500,000 on the waiting list in Wales, 17% of the Welsh population
  • The total number of elective procedures in Scotland was down by a third from 2019 to 2020
  • In Northern Ireland, 75,000 people are waiting greater than 2 years for a first appointment with their surgeon

The NHS has responded with the welcome investment of over £1 billion to support the transformation of perioperative care pathways. But while boosting capacity and increasing efficiency must be seen as a priority, to view the problem simply in terms of the numbers of surgical procedures to cross off a list is to overlook a large part of the problem.

We have witnessed a deterioration in the health of our population on the whole during the pandemic, and the most vulnerable members of society have been disproportionately affected. People have been forced inside, levels of physical activity have dropped and our nation’s eating habits have deteriorated. If we do not address this physical and mental deconditioning of patients prior to surgery we can expect to see significant downstream effects, including higher surgical complication rates, soaring healthcare costs and increased rates of burnout and fatigue amongst our healthcare staff.

So while extending theatre operating times, and increasing the number of procedures done as day cases remains key to navigating this immense challenge, we are perhaps overlooking the greatest asset we have at our disposal — the people awaiting surgery themselves. It is a fact not overlooked by NHS leaders either, 49% of whom said in a recent survey commissioned by the Centre for Perioperative Care (CPOC) that they believe that patient-centred initiatives are crucial to addressing the surgical backlog.

Patient-centred care simply refers to a model of care where patients are supported to actively participate in their own management, in collaboration with the clinical team. It is not a new concept — we realised as a profession many years ago that simply telling patients what to do is ineffective, and oftentimes counterproductive.  Several successful examples of patient-centred initiatives have been implemented in the NHS in recent years, including Kate Granger’s widely praised “Hello, my name is…” campaign, but now is the time to do more.

Evidence emerging over the last number of years has demonstrated that patients have an important role to play in their preparation for surgery, an area of perioperative care now referred to as prehabilitation. It is thought that as many as 1 in 2 postsurgical complications are preventable when patients are supported to address their modifiable risk factors for surgery, through person-appropriate lifestyle interventions.

At Sapien, we have known about the resourcefulness of patients for some time, which is why we developed the world’s first Digital Prehabiliation Clinic. We don’t just tell patients what to do and why, we teach them how, using expert health coaching as the key to unlock every Sapien Member’s potential. Our message is simple: we’re changing waiting lists to preparation lists.

Every Sapien Member is paired with their own dedicated Sapien Coach, who works to guide them along their surgical journey and come up with health management strategies that work for them. Members also have access to the Sapien app where they follow their personalised lifestyle medicine programme, and can monitor and track their own progress.

We are currently live in several NHS Trusts in England and our outcomes to date have been very encouraging. Patient Activation Measure (PAM®) — a measure of patients’ knowledge, skills and confidence to self-manage — has increased by an average of 10.5 points from programme entry to exit. We have also commissioned a cost-effectiveness analysis by York Health Economics Consortium which found an expected cost-saving of £564 for every total knee replacement patient who takes part in the programme.

What is PAM?

PAM is a 13 item survey that assesses a person’s knowledge, skills and confidence integral to managing their own healthcare.

It segments individuals into 4 levels across a 100 point scale and reliably predicts future A&E visits, unplanned hospital admissions, and patient adherence to prescribed management.

It has been validated across hundreds of peer-reviewed studies, with each 1 point increase correlating to a 2% decrease in unplanned hospitalisations. 

Moreover, our members have loved the experience, with an average Net Promoter Score of 86 amongst those who have completed the programme. Here’s what 68-year-old Sapien member Dorathy had to say, who is currently awaiting a hip replacement:

“ In 12 weeks I’ve lost 13kg and I feel fitter, less lethargic, and mentally better. I used to feel as if I was asking for help but not getting anywhere — it was like I was banging my head against a wall. Now, I’ve got a more positive attitude. I know that I have the power to positively change my own health.” 

Stories like Dorathy’s fill us with hope, and demonstrate that despite all the negative effects of the pandemic, there is still plenty of cause for optimism. The perioperative community has been afforded a unique opportunity for rapid, digitally-enabled transformation, which will only benefit patients and providers in the long term. As clinicians, now is the time to make the transition from expert to enabler, and empower patients to take control of their own health forever.