The NHS is testing whether it can cut its record elective surgery waiting list by moving simple operations like hip replacements and cataract removals out of busy acute hospitals and into dedicated "high-volume low-complexity" surgical hubs. The COVID-19 pandemic created a massive backlog of patients waiting for routine surgery. In acute hospitals, these patients compete for operating theatre time and staff with emergency cases and complex procedures. The HVLC hub model ring-fences specific staff and facilities to treat only straightforward elective patients, aiming to increase throughput and reduce waiting times. This four-year mixed-methods study will evaluate whether the hubs actually work. The researchers will compare hospitals that have adopted hubs against those that have not, using routine NHS data to measure changes in surgical volume, patient length of stay, and productivity. They will also conduct in-depth case studies at up to nine hub sites, interviewing staff and observing how the model operates in practice. A dedicated work package will assess costs and workforce impacts, including whether the hubs simply shift pressure onto emergency departments elsewhere in the system. If the model proves effective, it could reshape how the NHS delivers routine surgery nationally, potentially reducing waiting times for millions of patients without requiring additional funding or staff.
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Research questions What is the impact of HVLC hubs on productivity, patient care and the workforce and what is the differential impact of different service models of HVLC hubs? Background The COVID-19 pandemic resulted in cancellation of a substantial amount of elective surgery, leading to lengthening waiting times, and exacerbating a backlog of patients awaiting treatment. Existing models of elective care often involve patients being treated in acute hospitals, where staff have competing demands from more complex, urgent and emergency care. To tackle the backlog, NHS England’s elective recovery plan aims to increase elective care throughput of the NHS. The high-volume low-complexity (HVLC) surgical hubs model has been proposed to achieve this aim, improving efficiency and productivity by ring-fencing staff and facilities in particular locations to drive efficiencies in the elective care pathway and treat low complexity elective patients more quickly. Aims and objectives 1. To characterise the implementation timing, scale, scope and staffing of HVLC hubs currently working/being set up in England 2. To determine the impact of HVLC hubs on outcomes including volume of activity, patients’ length of stay, waiting times and productivity 3. To explore the impact of HVLC models on professionals working in the hubs 4. To explore the impact of HVLC hubs on the wider local NHS including negative spillovers in other areas of the NHS (e.g. emergency care) and workforce issues across the wider trust(s) 5. To assess the impact of HVLC hubs on patients and carers 6. To explore the implementation of HVLC hubs – how have changes been enacted and experienced and what are the barriers and facilitators to implementation 7. To compare resource utilisation and costs of care across different service models and typologies of HVLC hubs Methods We propose a mixed method evaluation consisting of six integrated work packages including a quasi-experimental evaluation using routine data sources and qualitative case studies, using the Consolidated Framework for Implementation Research (CFIR). All of our work packages will be informed by our stakeholder advisory group and PPI representatives. We will perform a quasi-experimental evaluation of the HVLC hubs programme using the variation in timing of implementation of HVLC hubs across England to perform a staggered difference-in-difference methodology to examine a range of routinely collected outcomes. We will also analyse data on outcome variables which will capture spill-over effects of the HVLC hubs program. Integrated with the quantitative findings we will purposively sample (up to nine) HVLC hubs for qualitative in-depth case studies. Data collection at sites will consist of non-participant observational data, semi-structured qualitative interviews and documentary data. We will have a work package dedicated to workforce and the overall cost impact. There will be three iterations of both the quantitative and qualitative work across the duration of the project. Timelines/Anticipated impact This is a four year project, however, regular feedback of interim study outputs will be disseminated to appropriate policy stakeholders to inform ongoing implementation of the HVLC hubs programme. Our iterative design and policy feedback mechanisms will allow the findings from our research to have immediate impact.
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