Seven ways insourcing is helping address patient backlogs in elective care

In February the NHS launched its delivery plan for tackling COVID-19 backlogs for elective care[i] with the objective of providing 30% more elective activity by 2024/25.

There are 6 million patients on waiting lists for elective care and Trusts face ongoing system-wide pressures including high staff sickness due to COVID-19.

Finding solutions is a constant challenge and in this article, Sam Tennant, Operations Director at Xyla Elective Care, looks into the ways NHS Trusts are best using insourcing to support not only the urgent, short-term needs but the longer-term solutions as well.

Xyla Elective Care, part of the Acacium Group, is an NHS framework approved insourcing partner providing clinically led, fully managed specialist services to create additional clinical capacity.

Their services bring together patient flow, diagnostics, surgery and outpatient care, assuring quality and patient experience through the design and delivery of solutions to patient backlogs and improving outcomes for patients.

1. Wider labour market access

The goal of 30% more elective care requires additional clinical capacity to achieve it and the major challenge is workforce availability. An independent insourcing specialist like ourselves gives wider access to a pool of professionals who choose not to work in the public sector or supplement their substantive NHS work.

An important point is that investment in insourcing to make material headway in reducing patient backlogs should be considered as a partnership approach. The Trust is investing in a partner who will build a specialist team for them and are accountable for quality risk management (patient safety, safeguarding and information governance) and compliance (finance and staffing).

Through open and transparent communication, the partnership thrives on delivering best value, reducing patient wait lists and improving patient outcomes.

Added value investment includes helping the Trust transition from an independent temporary workforce to a permanent workforce, helping to build internal capacity for the longer term.

2. Fast mobilisation

The NHS Backlog plan highlights that workload pressures pre-existed the pandemic and that targeted action to address shortages is critical to recovering elective care services.

Insourcing as a short/medium-term solution can help fill a gap where Trusts are currently dealing with staffing pressures and Covid-19 staff sicknesses. Specialist personnel and teams can be mobilised at short notice, fully equipped, trained and ready to deliver services under the Trusts CQC registration.

An added benefit is that while the short/medium term capacity needs are being addressed the Trust team can focus on their longer-term recruitment plans and on the retention and upskilling of existing staff.

3. Effective triaging

An experienced team of insourcing specialists will design and implement more tailored solutions which bring cost savings to NHS Trusts. One way is through effective management of triaging and identifying the priority cases. Low-risk patients can be triaged and potentially referred to primary care with advice and guidance and/or community/virtual based services.

Further added value comes through the management of triaging at a system-wide level with the insourcing provider aligning with the patient pathways of the local Trusts, tailoring the service to how they operate and managing the patient journey end-to-end, with involvement of primary, secondary and community-level care partners.

Engaging a partner that is experienced in this level of system-wide delivery is crucial to finding longer-term solutions to challenges and often results in better outcomes at all levels.

4. Virtual Solutions

The NHS planning guidance includes the use of digital technology and advanced data systems to improve access to information and services which support the prioritisation of those in most need.

Virtual solutions can take time to plan and facilitate and it can be challenging to solve issues that require a more immediate response. Choosing a partner with proven experience and ready-to-go solutions will help speed up implementation.

5. Physical infrastructure

Insourcing is often perceived to be solely about increasing capacity through bringing in teams of people, but working with experienced, large-scale operators can provide complete solutions which include physical infrastructure.

The supply of mobile/modular units or other physical space and the equipment to deliver services helps make a blend of insourcing/outsourcing a cost-effective solution for short-term recovery of services or when an additional resource is needed to support an unexpected or urgent demand.

The independent specialist sets up and delivers the additional capacity faster and more conveniently for Trusts, relieving the Trust’s team from needing to provide a physical space for the delivery of a service, or the equipment needed, where these are already in short supply.

6. Flex in service management

One of the drivers for Trusts to engage with an insourcing provider is that the contract can be designed to allow for capacity to be flexed up and down depending on patient list numbers, improving cost efficiency.

An insourcing partner provides a flexible resource whereby capacity can be increased or decreased as and when needed.

For example, at one London NHS Trust we run seven services. At the start of the contract, we had an initial batch of agreed work, and then the remainder of the contract has no value assigned to it; this gives the Trust ability to ask for X or Y service at short notice and gives them enormous flexibility to respond to internal pressures during the remaining lifetime of the contract whilst ensuring continuity of quality service provision.

7. Collaboration helps find long-term solutions

Whilst the traditional perception of insourcing is that it’s a service of last resort, those NHS Trusts who are commissioning insourcing at an earlier stage are better placed to prevent a crisis.

At Xyla Elective Care we focus on collaborative working with all of our healthcare partners to not only cover short-term solutions, but to also focus on longevity and how each partner can build internal capacity over time.

To learn more about Xyla Elective Care and insourcing solutions, contact us on