BSLM Response to the Elective Reform Plan announced on 6 January by NHS England (NHSE) and the Department for Health and Social Care (DHSC).

BSLM welcomes the publication of the Elective Reform Plan setting out how the elective care for patients in England will be reformed and how an NHS fit for the future will be built.

The plan’s emphasis on person-centred care, putting patients at the heart of the proposals, is welcome as this is a key principle of lifestyle medicine which uses a holistic approach in consultations with patients to understand what is important to them for their own health and care.

BSLM welcomes the proposal to use the waiting period to prepare patients for surgery. This includes assessing their health status and behaviours, followed by tailored interventions to improve their health. The offer of prehabilitation programmes that provide support for exercise, nutrition, weight reduction, smoking cessation and avoidance of alcohol for 4 weeks prior to surgery is crucial. Evidence demonstrates that many patients undertaking these programmes may no longer require surgery. Our MSK Special Interest Group are experts in this field, and are able to support with practical advice and evidence for Lifestyle interventions should it be required.

These programmes also ensure that patients are healthier at the point of surgery which lowers the risk of last-minute cancellations, complications, and extended stays in hospital. It would be helpful to have clarity about which patient groups will have access to this support. We believe that prehabilitation programmes should be provided to all surgical patients who could benefit from them. 

The focus on delivering care closer to patients from community diagnostic centres is also welcome but this must be matched with good data collection to understand how effectively they are operating and to ensure over investigation and over diagnosis is avoided.

The use of group appointments – also known as group consultations or shared medical appointments – is also a well evidenced technique for working with patients with chronic conditions and are both effective and efficient and would be helpful in terms of supporting patients ahead of proposed surgical intervention. BSLM has a network of clinicians working with group appointments, so again, would be happy to support in any way.

The BSLM advocates for preventive healthcare that focuses on addressing the root causes of ill health through more policy and public health at a population level and more training and resources to offer lifestyle medicine in consultations. The preventive healthcare agenda must avoid being hijacked by those with vested interests in more testing and more prescribing. This approach often fails to address the root causes of ill health. Policy, public health and lifestyle medicine are more effective, sustainable and equitable than excessive or harmful over-testing and over-prescribing. Lifestyle Medicine also considers the upstream determinants of health, with a focus of care on those hard to reach communities who do not readily engage with health systems.

~ BSLM Clinical Forum.

For more information contact BSLM at office@bslm.org.uk, https://bslm.org.uk/