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Inspired by Disneyland: Worthwhile waiting in Cambridgeshire

What we did

We combined ideas from the literature on the psychology of waiting and pre-habilitation to inform our project. We have offered regular Health Coaching appointments to people on waiting lists for knee and hip surgery. The support we offer includes one-to-one consultations, advice and regular updates by phone and email. In addition, we work with local social prescribers to give people the opportunity to engage in a wide range of events and activities provided by our partner organisations. These include all kinds of activities such as nature walks and mindful movement sessions, emotional wellbeing and debt advice. The aim is that people arrive at their clinical appointment in the best possible physical and mental health.

The difference we are making

People report feeling happy to have regular contact with our team, and enjoy the activities our partner organisations provide. We are in the early days of the programme so do not yet have our own data, but evidence from similar interventions shows patients are happier and healthier, and that they visit their GPs less frequently

See attachment and contact Will for all enquiries. 

edited on Jan 25, 2022 by Bev Matthews
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Bev Matthews 10 months ago

Thank you Sarah for posting your idea. I love how we can be inspired by fields outside of health and care to find innovative solutions.

Tagging others here who will be interested too

Reply 2

Andrew Bennett 10 months ago

Really interesting, thanks for sharing. What was the demand for this and resource required to deliver. Would als be interested in how you are looking to measure impact on the health and wellbeing of your cohort

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Will Bailey 10 months ago

Hi Andrew, uptake is around 10%.

We used £16,000 to set the service up, but it would be much cheaper to replicate. The money was used to scope the project, fund literature reviews to ensure the programme was informed by data, to create the website etc. Lots of one off costs. We intentionally did not want to create something which would cost the system and require lots of money to commission: Health coaches are fully funded under the ARRS scheme, and the partner organisations we teamed up with are already funded to deliver their courses/activities/content.

We have partnered with a local university to develop an evaluation framework. As the cohort in the first year is a relatively small sample, we decided to use self-report measures (all well-validated). I strongly suspect fewer GP presentations is a likely result, but with small number of participants, impossible to prove. The evidence for pre-habilitation programmes in general is overwhelming: reduced complications, reduced bed days post-op, happier and healthier patients etc.

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Reply 4

Cathy Sloan 10 months ago

Thanks for the additional detail Will. Was the 10% uptake expected? Are there opportunities to increase uptake? What reasons did people give for not taking part?

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Will Bailey 10 months ago

We anticipated a higher uptake, but that was probably wishful thinking as when we've talked to people doing similar projects, they have similar figures.

I think there are certainly ways to increase this. We have recently changed our invitation letter to be a bit more directive which I think will help. I also think that if we can convince the local system to implement this approach more widely and it becomes the standard way people on waiting lists are treated, more people will come on board. Finally, the offer remains open to people while they wait, so it is possible people will join the programme when they start to recognise that their long wait is causing problems which the programme might help with.

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Cathy Sloan 10 months ago

Thanks Will, super speedy response! It would be great to see this become standard practice

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Andrew Bennett 10 months ago

Thanks massively for sharing. Really interesting. What's your demand, and capacity required to deliver. Also interested on how your planning to measure impact on the health and wellbeing of those engaging

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Andrew Bennett 10 months ago

Thanks @WillBailey. Really interesting work and thanks for the rapid response. I am sure there will be lots of interest in this from the community. Sharing ideas such as this is absolutely what we are looking for. Also key principles that can be adapted and adopted by other systems

Have you explored other points of access as well as GP. I am thinking from local secondary care providers too

Reply 1

Will Bailey 10 months ago

Hi Andrew. We are working with our local hospital (Addenbrooke's) to discuss rolling this model out to other specialities, and to enhance our offer by combining it with their fit4surgery and pre-assessment service.

I think the "old" model of calling patients for pre-assessment a few weeks before their intervention made sense when they were only waiting a few months and hadn't had so long to decondition. However, with waits as long as they are, patients ought to be given advice about how to stay healthy for surgery at the start of their wait, not at the end!

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Leigh Kendall 10 months ago

Love this idea, prehab and health coaching are really important. Coaching is vital to help manage people's expectations of their own recovery, understand what recovery means to them, and to help them understand what they'll need to do after their operation to help themselves.

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Chloe Stewart 10 months ago

Thanks so much for sharing this project Sarah - what a fantastic idea.

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Cathy Sloan 10 months ago

Thanks so much for posting Sarah; the service sounds amazing. I particular like the positive psychology approach and how we can change perception of waiting from a wholly negative experience to one where patients can use the opportunity of services such as this to improve or maintain their health and wellbeing. It would be interesting to see how people who go through this feel about staying active once they've had their surgery.

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Devon Elliott 10 months ago

I would be keen to hear what metrics you have in mind regarding evaluation.? It also sounds like a good amount of the initial set up costs which were around evidence, would not be needed if scaled elsewhere potentially making it even cheaper to put in place??? nice read about 'the acceptance of people waiting' too. The integration with ARRS roles is that systematic step that can make a difference as well as working with the local acute trust.

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Will Bailey 10 months ago

Hi Devon,
We are using
Thanks for your comment! You're absolutely right about how cheap it would be to expand roll out this service more widely. We got the IP rights to our website design from our developer, so we can share a white-label version of that too.

The following are the anticipated outcomes for patients involved in the programme:
a) Improved clinical outcomes
b) Improved patient experience/quality of life
c) Improved patient competence in managing their own health
d) Improved physical and mental wellbeing
e) Reduction in isolation

I attach our evaluation framework if you'd like to read more about how we plan to assess these.

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Kate Pound 10 months ago

Could we pull other ideas posted into this one and them work as a group together to build this solvation.

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Dan Fielder 5 months ago

This sounds like a fantastic idea! Using Health Coaches and supporting the mental health needs of this patient group are so important.

Through a clinical partnership between The Royal National Orthopaedic Hospital Trust and the Royal Free London NHS Foundation Trust, and wider collaboration with the Enfield ICP, Barnet, Enfield and Haringay Mental Health NHS Trust and North Middlesex University Hospital NHS Trust, we are planning something similar for patients with long waits for hip or knee joint replacement surgery.

We understand that these patients have an increased risk of clinical deterioration whilst waiting for surgery. By offering 1:1 or group pre-habilitation, we are aiming to help support and empower the patient so that they are physically and emotionally ready for surgery. Additional benefits may also include reduced post-operative complications and improved post-operative recovery.

Our MDT approach will aim to utilise the best of physiotherapy, dietetics, psychology, OT and social prescribing.

We have no data yet as we are only in the early pilot/planning stage.

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Kate Pound 4 months ago

We could learn more by looking at Greater Manchester https://whileyouwait.org.uk/

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