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Risk stratifying elective care patients

The NHS has been instructed to make plans for the resumption of elective care by its Chief Executive Simon Stevens.

The letter he sent was all about risk stratification.

Organisations need to be working now on identifying clinical risk for its elective patients and prioritising accordingly. This is the ‘new normal’ for elective services and is likely to be in place for more than a than a year. When looking at clinical risk, it needs to take account of all patients regardless of the waiting list they are on. The NHS has been accustomed to prioritising referral to treatment (RTT) patients in order to meet national targets. What needs to change?

Prioritising scheduled care using clinical risk criteria means that NHS trusts will have to look beyond RTT patients that are often at the forefront of actions, because they are nationally reported and subject to more scrutiny from regulators.

Systems will need to understand the entire architecture of scheduled care demand and make informed resourcing decisions based upon that knowledge and understanding. This is something that Simon Stevens’s letter made clear.

Firstly, it will require an updated Governance Framework that aims to collaborate Hospital Clinicians, Managers, Informatics, Estates and Primary Care.

We have set out the architecture for elective care that includes the specific groups of patients that should be prioritised across all waiting lists they are sitting on:

What does this mean in practice?
Two of these lists (Cancer and RTT) are well known and easy to identify. The other three less so – urgent work should be underway now to get these in place.

This gives the system 4 priority groups of patients that require plans for treatment, regardless of where they are in the elective process.

Once these groups have been identified and reviewed, the governance framework will need to assess infrastructure, estates and workforce issues that may impact on the ability of organisations to treat each group.

The output of this risk stratification will be a plan that clearly sets out how the system plans to deal with each priority group of patients.