The last winter crisis: How digital transformation of the NHS can address the elective surgery backlog

Originally published by Health Tech Digital

Every winter, the NHS faces a recurring challenge: a surge in demand that strains its already overstretched resources. As a senior NHS clinician, I see firsthand how these pressures impact patient care and the broader health system. While the Darzi report does not focus specifically on winter pressures, it highlights digital transformation as a key solution to these systemic issues.

In response, Chancellor Rachel Reeves’ Autumn Budget 2024 has allocated substantial funding to address NHS inefficiencies, reduce waiting lists, and support digital transformation across the health service. With this investment, we have the opportunity to build a more resilient NHS that can better withstand the winter storm. So, how can digital health solutions play a pivotal role in achieving these goals?

Winter pressures: A growing threat

The Autumn Budget delivers much-needed funding to help the NHS address these seasonal challenges. With an additional £22.6 billion allocated over two years, the Department of Health can address urgent care needs while reducing elective surgery backlogs. This funding includes £1.5 billion for new surgical hubs, diagnostic scanners, and beds across the NHS estate, supporting more efficient patient flow and increased treatment capacity during peak demand

Despite this support, the NHS still faces what many believe will be its most difficult winter yet, with seasonal flu, rising COVID-19 cases, and a record number of patients awaiting care. Persistent staffing shortages and healthcare worker burnout compound these pressures, with an estimated 111,000 vacancies further limiting the NHS’s ability to manage winter demand.

Having worked in the NHS for over 20 years, I understand how these seasonal challenges impact elective surgeries. Every winter, NHS hospitals must make difficult decisions to postpone planned procedures to prioritise emergency care. While necessary, this shift adds to the elective surgery backlog. By 2023, the number of people waiting for consultant-led care had surged to 7.77 million, up from 4.57 million in February 2020. NHS data shows that in the three months leading up to December 2022, over 21,000 operations were cancelled at the last minute due to non-clinical reasons, a clear sign of winter pressures well before the season’s peak.

Despite the government’s Elective Recovery Plan aiming to eliminate NHS waits over 18 months by April 2023, the number of patients facing extended waits has continued to grow. By December 2022, over 54,000 patients had been waiting longer than 18 months, with the longest delays affecting Trauma and Orthopaedic treatments, impacting nearly 800,000 patients. The Darzi report notes that by mid-2024, more than 300,000 patients had been waiting over a year for elective surgeries, significantly affecting outcomes and quality of life.

Digital transformation: A path for resilience

The Darzi report calls for a more resilient healthcare system, with digital transformation at the core. The government’s recent Budget, which directs significant resources toward health tech, underscores the role of innovation in achieving sustainable NHS improvements. By digitising key patient pathways and leveraging digital tools, the NHS can better manage heightened seasonal demand, improve efficiency, and reduce the impact of winter pressures.

The recent funding commitment aligns with this vision, providing NHS trusts with the resources to implement digital solutions that improve patient outcomes and reduce operational strain. Here are three ways digital transformation can directly contribute to reducing winter pressures and clearing the elective surgery backlog.

1.Digital pre-operative assessments (POAs): Streamlining pathways

Pre-operative assessments are vital for determining a patient’s suitability for surgery and to ensure they are adequately prepared. Digital POAs, or ePOAs, streamline this process, allowing healthcare providers to triage patients effectively, identify those at risk of complications, and enable timely interventions. This ultimately optimises surgery schedules and reduces the likelihood of last-minute cancellations, especially relevant winter when resources are stretched.

For example, The Royal Surrey NHS Foundation Trust recently implemented a digital pre-operative health assessment solution to reduce the backlog of 7,000 patients awaiting surgery and improve a legacy pre-assessment pathway that only met the needs of 30% of patients. An independent study found this new solution reduced face-to-face appointments by 34% and decreased ‘Did Not Attend’ (DNA) rates by 95%, ensuring more patients proceeded to surgery as planned and minimising disruptions to the surgical schedule.

Getting it Right First Time (GIRFT), a national NHS England programme, has introduced the Elective Hub Toolkit to support surgical hubs in adopting best clinical and operational practices, including digitised POAs. Solutions like digital POAs align with the Chancellor’s goals for more efficiency in healthcare, enabling NHS trusts to maximise limited resources without compromising patient safety.

2. Virtual wards: Reducing hospital stays

The Darzi report highlights the importance of reducing unnecessary hospital stays, particularly during surges in emergency admissions. Virtual wards offer a solution by enabling patients to report their recovery progress and receive support at home while maintaining high standards of care. The South West London Elective Orthopaedic Centre, the UK’s largest joint replacement centre, has successfully implemented a remote surgical care pathway, significantly improving patient care and operational efficiency.

The numbers reflect the model’s success: Consultant wait times for both new and follow-up patients was reduced by four weeks, enabling early intervention for patients not recovering as expected at the ideal six-week mark. Out of 622 patients, 93% successfully entered patient-initiated follow-up (PIFU) pathways, with only 7% requiring face-to-face post-op consultations. This created additional capacity of 520 consultant clinic slots, equivalent to 34 half-day clinics. Over a three-month period, 12 consultant clinics converted to theatre sessions, with 35 additional patients undergoing surgery.

This approach, which has proved particularly effective for post-operative care, could allow for earlier discharge throughout the winter while maintaining patient safety and clinical standards through remote monitoring. The result is improved bed availability for patients requiring acute care. With NHS funding directed toward new surgical hubs and virtual wards with enhanced post-operative care pathways, more NHS trusts can implement these solutions to free up beds during winter without sacrificing patient outcomes.

3. Predictive analytics: Identifying risk

AI and machine learning are also powerful tools in addressing NHS winter pressures. Predictive analytics can help identify patients at higher risk of complications, enabling more informed surgical planning and better resource allocation. By integrating AI technology into clinical workflows, the NHS can improve efficiency, enhance patient outcomes, and use resources more effectively during peak demand.

Research by the University Hospital of Sussex, presented at the British Orthopaedic Association Annual Congress, demonstrated how machine learning and predictive analytics enhance risk stratification for surgical patients. By identifying key risk factors influencing post-operative outcomes, this approach has the potential to transform clinical decision-making, enabling more personalised and precise patient care, especially important during times of high pressure.

A digital future for the NHS

The Autumn Budget provides a strong foundation for addressing winter pressures and elective backlogs through increased funding and a focus on efficiency. From a surgeon’s perspective, the future resilience of the NHS hinges on adopting digital innovations. By integrating these technologies, the NHS can address both immediate and long-term challenges, creating a more sustainable and resilient healthcare model that better serves patients year-round.

I have witnessed how digital solutions, particularly in surgical pathways, can streamline processes, reduce inefficiencies, and improve patient outcomes. These innovations will not only alleviate winter pressures but also build a more robust healthcare system capable of managing peak demand with greater flexibility and efficiency.

To achieve this transformation, collaboration among key stakeholders, including policymakers, healthcare providers, technology developers, and patients, is essential. With effective implementation, the NHS can fully harness the potential of digital health, improving patient care, optimising resource use, and building resilience to manage seasonal pressures.

The recurrent winter crisis will continue to challenge the NHS, but digital health solutions present both a viable and sustainable path forward. With the right investment and collaboration, the NHS can transform into a digitally enabled service that delivers timely care, improves patient outcomes, and builds a healthcare system ready to withstand future challenges, offering hope that this could be the last winter crisis the NHS has to endure.