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Elective doesn’t mean optional

Sue Brown

On 8 February the NHS published the plan for tackling the backlog of “elective” care built up during the COVID-19 pandemic. The term elective seems to me to be a bit misleading, as though this is care you might elect, or choose, to have. Something which might be in some way optional. What we are in fact talking about is care that is essential, but not urgent or an emergency. What impact does the use of this term have?

  • Hospital waiting lists
  • Person-centred care

In my view, it downplays the seriousness of that care, making it more likely to be put on hold when resources are stretched. This is care which, before the pandemic was supposed to be delivered within 18 weeks. It can wait a bit longer than, say, a broken bone or a stroke, but not indefinitely.

What happens if people wait too long?

If we take an example, hip and knee replacements. A large percentage of those on the current waiting lists are waiting for hip and knee surgery due to arthritis. People waiting for hip or knee replacement are in pain. They find it difficult to get around, to work, to care, to live a full and active life. People can usually manage this if they know they will wait no more than 18 weeks, but we now have thousands who have been waiting over two years. People are struggling, they are losing their jobs, becoming isolated from friends, family and leisure activities.

Viewing this care as “elective” has meant that in successive winters people have had operations cancelled to make way for more urgent cases. Viewing this care as elective at the start of the pandemic led to all such treatment being paused for three months. Then when those three months were up and the pandemic was not over, people were asked to wait longer, and with each successive wave of the virus, still longer.

This is not something that surgeons want. They are frustrated that they can’t deliver what they know to be life changing treatment. They are acutely aware of the impact on those waiting.

Supporting people waiting

Now we have the elective care recovery plan, which contains some stark predictions: waiting numbers will not start to fall until 2023; one year waits will not be eliminated until March 2025. The plan recognises that it is vital to provide people with support while they wait.

This cannot just be information, or signposting. It cannot be asking people to repeat the programmes they have tried before to avoid the need for surgery; they wouldn’t be waiting for surgery if those had worked. People need personalised support with the physical, mental, social and financial impact of waiting, support to remain in work and to keep as active and healthy as possible so that they are ready for surgery when their turn arrives.

Here’s what I think is needed to support people waiting for vital treatment, not just hip and knee replacement but all community and secondary care that has been delayed.

  • Design support with those with lived experience – ask what is important to them.
  • Use the things we know can help, like social prescribing and health coaching – individual or group personal support.
  • Use the voluntary and community sector who have a wealth of experience in supporting long term condition management – people need to know they are not alone and get support from others in the same situation.

More importantly, longer term, we need to change our thinking about “elective” care and design an NHS that values the lives of those with non-urgent needs, like arthritis and other musculoskeletal conditions, equally with those with urgent needs.