NHS England National Perspective – Enhanced Recovery Care Pathways: a better journey for patients seven days a week and better deal for the NHS Dr Celia Ingham Clark, National Clinical Director for Enhanced Recovery and Acute Surgery, NHS England Presentation from Shaping the Future Direction of Enhanced Recovery Care Pathway Seven Days a Week workshop held in London on 5 December 2013

1. NHS England National Perspective – Enhanced
Recovery Care Pathways: a better journey for
patients seven days a week and better deal for
the NHS
Celia Ingham Clark,
National Clinical Director for Enhanced Recovery
and Acute Surgery, NHS England

2. Aligned to the NHS Outcomes Framework
ER is “big cog” in a whole
pathway
“Enhanced Recovery is a solid
platform to build upon, ER is a
strong concept and we have
the opportunity to widen this
further along the care
pathway and continue to
generate evidence of its
impact”
Professor Keith Willett

3. Progress and level of ambition
• Quality is the driving
principle
• Key components – 5 P’s
• Good progress made
• Extend principles of ER
beyond elective
practice
• Integrate ER across the
whole system

4. Progress: ER is becoming the norm
“We believe that
enhanced recovery
should now be
considered as standard
practice for most
patients undergoing
major surgery across a
range of procedures
and specialties”.

5. ER is about simple steps
to get patients
better sooner

6. Good progress has been made:
A patient centred approach
• Patient involvement
and shared decision
making at the heart of
ER
Designed by patients for patients
• The potency of patient
involvement helps to
drive spread and
adoption of ER

7. 92%
89%
86%
78%
74%
Progress: ER improves patients experience
……………………………… patients get better sooner
Patient Experience: Enhanced Recovery compared to National Inpatient Survey
1
94%
86%
0.9
0.8
95%
92%
78%
89%
84%
74%
0.7
0.6
0.5
0.4
0.3
0.2
as much as you How much information about Did you feel you were involved in Did hospita
t your0.1
care and your condition or treatment was decisions about your discharge contact if y
ent? 0
given to you?
from hospital?
your condi
Were you involved as much as you How much information about Did you feel you were involved in Did hospital staff tell you who to
yo
wanted to be about your care and your condition or treatment was decisions about your discharge contact if you were worried about
treatment?
given to you?
2011-Enhanced Recovery
2011-Enhanced Recovery
from hospital?
your condition or treatment after
you left hospital?
2010-National Inpatient Survey - elective only
2010-National Inpatient Survey - elective only

8. Progress: ER reduces length of hospital stay
Falling length of stay
70,000 fewer bed days
Increasing day of surgery
admissions
No increase in readmissions

9. Progress: ER increases day of surgery admission
Increasing day of surgery
admissions
No change in readmissions

10. We know the Job is not done
…………………
But it’s a job worth doing

11. We know the Job is not done - variation exists
Variation in
- spread and adoption to other
elective surgical procedures
- momentum of spread in
existing procedures
Early testing in
- emergency and acute medical
- maternity pathways

12. Obstetrics: Elective C - Section

13. Summary and future levels of ambition
• Increase patient engagement to empower
patients
• Ensure all patients get the same standard of care
seven days a week – spread to non-elective care
• Develop systems to optimise patients fitness for
referral and risk stratification to improve patient
safety
• Develop internationally comparable outcome
measures to further build the evidence
13

14. Orthopaedic:
Hip and knee replacement

15. Colorectal:
Colectomy and excision rectum

16. Urology:
Prostatectomy and Cystectomy

17. Gynaecology: Hysterectomy

18. Other surgical specialties