On 6 January 2025, NHS England (NHSE) and the Department for Health and Social Care (DHSC) published their Elective Reform Plan, outlining how they intend to tackle the elective backlog and build an NHS fit for the future. We welcome this plan which accepts and adopts many of the policies that we have long lobbied for, including in our “Blueprint for NHS efficiency” published prior to the 2024 General Election. 

We are encouraged by the plan’s emphasis on patient-centred care. We have long advocated for the adoption of true Shared Decision-Making between clinicians and patients. This should underpin all care decisions, ensuring patients are fully informed about their treatment options, including the benefits and risks, so they and the healthcare team can make choices that are right for them.   

We also welcome the proposal to use the waiting period to prepare patients for surgery. This includes pre-assessing their health status and behaviours, followed by tailored interventions to improve their health. They may be offered prehabilitation programmes that provide support for exercise, nutrition, smoking cessation, and much more.

Read CPOC's top seven perioperative care interventions 

CPOC has long called for waiting lists to become ‘preparation lists’, with evidence that the healthier patients are going into surgery the lower the risk of last-minute cancellations, complications, and extended stays in hospital. So while the plan’s proposals are a step forward, we believe the plan needs to be clearer about which patients will be able to access this support. Our recommendation is that it is provided to all surgical patients who could benefit from it. 

The ambition to reduce variation in discharge processes is an important one, but the plan lacks detail on how they plan to deliver this. Inadequate discharge planning remains a widespread issue throughout the NHS. Many patients stay in hospital longer than medically necessary due to insufficient support to plan their discharge and organise any necessary post-hospital care. They may also be readmitted to the system after discharge due to inadequate care, support, or information on how to self-manage. As such, to improve discharge processes, discharge planning must be a core focus of reform efforts.   

Routine data collection and analysis are essential for identifying best practices and targeting areas for improvement. CPOC welcomes the proposal to monitor productivity metrics, including length of stay and last-minute cancellations. However, we advocate for broader data collection for all patients on the surgical pathway. This should include information on co-morbidities, heath behaviours, time of pre-screening, decision to offer prehabilitation, and time of discharge. 

Technology plays an important role in reforming elective care, and we are supportive of plans to invest in this. Innovations to streamline service delivery and free up clinicians have the potential to significantly boost productivity. However, Information Governance must be carefully considered to ensure patient data is protected. We recognise the benefits of establishing a Task and Finish Group to develop and embed the delivery of elective care. As the established organisation in the UK who champion perioperative care, we see many positives in being a major contributor to this group from its inception.