What is the need?

Patients who are given appropriate support to ‘wait well’ for surgery are more likely to achieve positive outcomes pre and post-surgery. This might include help to manage and improve their health and wellbeing, and support to manage pain drug use. This benefits the patient and the NHS.

For the patient, they are more likely to recover well, and may even make longer term changes that improve their health and wellbeing (e.g. improved diet, exercising more). For the NHS it can reduce bed days, reduce cancellations and reduce the likelihood of readmission, thereby reducing costs and improving productivity.

A key facet of this is the use of pain medication. Many people waiting for surgery are put on pain medication to manage their symptoms. However, this can result in complex postoperative interventions, worse pain control (resulting in slower rehabilitation), delayed wound healing and increased risk of post-operative complications. The result is poorer outcomes for the patient and additional cost (hospital bed days, medication, staff time) for the NHS.

How will we meet the need?

PROSPeR is a pilot project that supports people on the waiting list for orthopaedic (e.g. hip and knee) surgery. Ways to Wellness link workers will support patients from pre- to post-operation, improving their health and wellbeing for their operation and beyond.

Our work will focus on helping people with ‘what matters to them’, such as healthy eating and diet, getting more active and getting involved in local groups and activities.

We aim to improve wellbeing and recovery for patients after their operation, often helping people to establish longer term improvements to their wellbeing. We will examine whether this also leads to reduced costs for the NHS due to things such as lower use of pain medication and reduced use of hospital resources (clinician time/bed days) post recovery.

The project is funded by the North East and North Cumbria Integrated Care Board's ‘Waiting Well’ programme.

What do we aim to achieve?

Our primary aims are:

• Improved postoperative wellbeing and recovery for patients having hip/knee replacement surgery
• Patients supported to ‘wait well’ and recover quicker, often with longer term healthy behaviours established
• The NHS will benefit from reduced costs due to reduced use of hospital resources (clinician time/bed days/ lower use of pain medication) post recovery.

Our secondary aims are:

• Improved support for patients electing to have major surgery —service developed/rolled out
• Improved clinician knowledge/understanding of the impact of non-clinical support on post-operative outcomes for patients.

Our long term aims are:

• Reduced health inequalities for patients requiring major surgery
• Greater coordination between NHS services and voluntary and community sector services
• An improved policy environment to deliver these types of intervention.

What is 'Waiting Well'?

'Waiting Well' is a regionwide programme that aims to support patients who are waiting for planned care such as knee and hip replacements.

Evidence shows that taking simple steps before surgery or treatment to improve fitness, diet and mental health plays a crucial role in helping patients to recover more quickly and reduces the chance of being re-admitted to hospital. By empowering them to manage elements of their own health and be in as good shape as they can for their treatment means that there is much less chance of their planned care being cancelled.

The Waiting Well programme will focus on approximately 70,000 people who are classed as 'Priority 4' patients, many of whom have been waiting for their treatment for a considerable amount of time. With that in mind, the Waiting Well programme considers mental health and wellbeing elements of their preparation and subsequent recovery just as important as any physical elements, particularly when you take into consideration that around 21,000 people in that cohort are in Deciles 1 and 2 which are the top 20 most deprived communities in the country.

Patients are contacted via letter and offered support and signposting to a number of useful services or resources. The patient letter will be followed up with a phone call from a member of their local support team to talk to the patient about their general health and wellbeing.

For further information, contact necsu.comms@nhs.net. If you need information on in a different format like accessible PDF, large print, easy read, audio recording or braille you can email necsu.marketing@nhs.net or call 0191 301 1300. They will consider your request and get back to you in 5 days.

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