There is no simple solution to solving the huge patient backlogs facing NHS trusts across the country and any strategies will need to take into account local variables, but one element that all roadmaps and strategies must adopt is effective patient communication. Denis Williams, Interim General Manager at Cardiff and Vale University Health Board, discusses the gains the health board has made by partnering with Healthcare Communications, now part of Webex by Cisco.
At Cardiff and Vale University Health Board, we have a long-standing recognition of the merits of effective patient communication and the benefits of digital technology to facilitate this. When faced with the prospect of needing medical treatment, patients can understandably be anxious and want to know what their care plan involves and when treatment will take place. Unfortunately, the COVID-19 pandemic created uncertainty for many patients as routine procedures needed to be suspended and, in similar scenarios within NHS trusts and health boards across the UK, our waiting lists grew. Patients understandably wanted to know what was happening and when their procedure would take place.
NHS England and NHS Wales quite rightly recognised the importance of reducing backlogs as waiting longer for treatment can mean an existing condition could worsen, thus resulting in more complicated surgery or increased use of medications, with slower recovery and worse outcomes potentially leading to reduced quality of life. Further to this, with an estimated 10 million patients who might otherwise have come forward for treatment but did not, there is enormous uncertainty surrounding future patient demand, and whether or not these patients will seek treatment, making it difficult to estimate the impact on health outcomes and waiting lists locally. The best we can do in preparation, is to ensure that patients on our waiting lists are triaged effectively and efficiently, and digital patient communication can help with this.
In April 2021 NHS Wales sent out a national request for all health boards to validate all patients who had been waiting over 52 weeks for their first outpatient attendance. The strategy behind this was two-fold: it would not only provide health boards with a clear picture of how many people still required surgery, it would also ensure that patients were reassured that they hadn’t been forgotten. While validating entire waiting lists is a huge undertaking, particularly for health boards or trusts without digital communication systems in place, the future gains make the investment worthwhile. The cost and efficiency savings of digital patient communications are well versed, and if effective regular communication is planned and implemented, it will save both administration teams and clinicians time fielding enquiries from patients wanting updates.
At Cardiff and Vale University Health Board, we were able to very quickly set up and implement our outpatient waiting list validation programme, thanks to our longstanding partnership with Healthcare Communications who have been supporting us to deliver proactive patient engagement solutions for some time. This includes SMS and voice appointment reminder solutions and the use of a digital correspondence platform to support our “Patient Participation” booking model for new appointments. Both of these processes adopt a digital-first approach, with the option for appointments to be delivered via SMS confirmed by the patient with one click. Alternatively, paper letters are automatically produced and sent to patients if they are unable – or choose not to – engage digitally. These letters contain information about an inbound, bilingual, interactive voice messaging (IVM) service that enables patients to call in and respond without putting increased load on the contact centre.
Due to the success of this system, it was an easy decision to use Healthcare Communications to validate our outpatient lists. We opted to send patients an SMS asking them to complete a digital questionnaire, with the platform automatically triggering a postal letter if the digital version wasn’t accessed or delivered. If the patient didn’t respond to the initial prompt they were sent a reminder 4-6 weeks later. If no response was received after another 4 weeks, the patient and referrer were advised of their removal from the waiting list, with the option to get in touch within 2 weeks to be reinstated. This system has enabled us to reduce our current backlog by 21%, which has no doubt saved us significantly by preventing approximately 1300 missed or appointments. We have validated all patients waiting over 52 weeks and have continued our waiting list validation programme beyond the NHS Wales target with the aim of validating all patients waiting over 36 weeks by the end of August 2022.
But it’s not just a numbers game. Behind every single number on our waiting list is a patient, and an important consideration is always clinical need. We need to consider the clinical urgency and the impact of waiting on individuals and the potential inequalities created by waiting for care. The questionnaire was designed to gain an understanding of what if any alternative treatment pathways a patient wishing to be removed from a waiting list may have taken, for patients remaining on the waiting list we asked how their condition was affecting them. The patient is also asked how they would rate their condition at present which may help with clinical validation. This strategy has a strong focus on patients, not only enabling us to prioritise those in greatest clinical need, but also enabling us to provide patients with more information and choice about their care, ensuring that we improve patient experience.
We now plan to move to a “See on Symptoms” and “Virtual Attendance” approach for post operative care and follow-up appointments. This will further help us to free up appointment capacity, as only those patients who require an appointment will be seen; anyone who is symptom free and managing sufficiently will be left to book an appointment only when required. This is a much more efficient system and one which our patients have found beneficial as it also saves them the hassle of attending an unnecessary appointment. This approach to digital patient communications is ultimately helping us to place patients at the centre of their care, providing them with the right information at the right time and helping us as a Health Board to address the backlog challenges effectively and efficiently as possible.