Developing a way forward for elective care post-Covid

University Hospital Lewisham


In the first few months of Covid, members of the Independent Healthcare Providers Network (IHPN) were trying to understand and quantify the Covid related impact on their throughput, and hence their finances. This was a particular challenge due to the readily changing and sometimes contradictory Covid related safety protocols.

In June 2020, IHPN engaged TN in a novel programme to estimate the operational and financial impact of these protocols on the delivery of planned activity within the Independent Sector (IS).

Approach & Output

Our work calculated throughput of planned care had fallen to 57% of pre-Covid levels, with a range ~40% to ~70% across 20 procedure types. In addition, managing Covid had cost implications which range from ~£4 to ~£160 per procedure type.

The process of developing these insights involved establishing a Steering Group and Working Group of subject matter experts within the Independent Sector and in the NHS to:

  • Synthesise protocols from a wide range of sources and agree applicable drivers of delays
  • Segment an exhaustive list of >5000 procedures into 71 procedure groups, and then into 20 archetypes. Analysis was completed at this archetype level and then summarised into five archetype groupings
  • Assign drivers of delay generated from protocols to each of the 20 archetypes and estimate throughput reduction (see below)
  • Estimate additional PPE and fixed costs not covered in existing contracts

Roadmap to recovery

Not accepting the “as is” reduction in throughput, and having the objective of delivering value to patients and the taxpayer, we worked with IHPN to chart a course to recovery. The roadmap to recovery we developed comprises three levers:

Identify and agree best practice implementation of protocols

  • A1 Agree to set and implement consistent industry-wide common practice
  • A2 Agree best practice with senior operational, clinical and IPC leads in the industry, challenging government guidance
  • A3 Implement consistently across all independent providers and sites

Increase operational productivity and efficiency

Utilise five areas of initiatives to mitigate delay drivers, capacity restrictions and additional costs

  • B1 Capacity
  • B2 Technology
  • B3 Workforce
  • B4 Scheduling
  • B5 Pathway

Shift mindsets

Crucial enabler required to realise the full potential of both A and B

  • Understand the mindsets that are causing the delays
  • Address these mindsets to move teams along the road to recovery

For the IS, the Covid challenge is a unique window of opportunity to achieve efficiency gains now which means throughput might be increased beyond 100% in a post-Covid world.

We built on this programme of work to co-author an article with IHPN in September 2020, which estimated the backlog of patients that had built up as a result of the reduction in throughput. This included an estimate of the “hidden” demand i.e. from the drop in referrals due to lack of access to GPs. This article goes on to establish, at a high level, a way forward through extending the collaboration between public and private sectors.

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