Elective Services: One System, One Waiting List

Covid-19 has clearly had a significant impact on the provision of elective services. It has been reported that nearly 50,000 people are now waiting more than a year for elective treatment.

Even prior to the advent of Covid-19, NHS waiting lists sat at a 10 year high with 4.4 million people waiting for elective care, 16% of whom were waiting more than 18 weeks for treatment. As the health service begins to reboot, all areas are looking at how we not only safely restart elective care but also clear the huge backlog, and all of this whilst looking to embed gains made in system-wide working and the use of surgical hubs.

We previously wrote about  prioritising your surgical waiting list but how do you ensure maximal use of capacity within your system including with partner organisations and the independent sector? One approach is to develop a single system-wide waiting list, which allows greater flexibility in theatre utilisation and ensures that, across the system, patients can be managed more effectively and equitably based on clinical need.

The idea of a single waiting list is not a new one for some organisations, be it through shared lists or ‘dear doctor’ referral letters into a service.  Expanding this concept into a wider system way of working will be based on an assessment of what type of single waiting list the system aspires to and where it sits: at point of referral, for diagnostics or when patients are ready for treatment.

Based on our experience of working with an STP in England to establish a single waiting list across multiple acute providers, the first step is to engage with clinical and managerial colleagues and agree the basic principles. These can include:

• We’re all in this together, and we can be greater than the sum of our parts
• We will have a single voice to the regulator and present a single version of the truth
• We will be transparent from the outset – sharing waiting time data across specialities at each site can often be an eye-opener and will encourage debate and ideas about improvement opportunities

Bringing clinical and managerial teams across trusts together and sharing data provide the fuel for ideas and solutions to generate.   Through our experience a number of factors should be considered in designing a locally appropriate and effective single waiting list system; for example:

Patient Choice

• What is the patient demographic?
• Are all sites within the system readily accessible by public transport?
• What distance are patients willing to travel to receive their treatment?
• How are patients informed that their first assessment and their treatment may happen in different locations?

Clinical Service Design

• How are suitable patients identified when adding to the waiting list?
• How are patients effectively triaged at the relevant stage of the pathway?
• Do all centres have the correct facilities and skills to diagnose/treat the patients?
• Can some treatments be undertaken by non-medical staff?
• Are clinical teams all working to similar clinical protocols?
• What are the standard clinical items required for safe and effective treatment?
• Are clinical teams already integrated at a system wide level?
• Are there systems in place to ensure that patients can be safely discharged from any part of the system?
• Are follow ups to be undertaken locally or via the treating centre?

Demand and Capacity

• Is there clarity on the available capacity across the system?
• Is there visibility of the system-wide waiting lists?
• What has been the impact of reduced activity on clinics and can new models of care release this capacity longer term?
• What are the opportunities for increasing theatre utilisation past 5 days?
• What opportunities are there for collaboration with the independent sector and for using estate downtime within organisations?

Systems

• Is key clinical information available across the system?
• Is there a single referral management function?
• Is there a single method for managing performance across the system?

Radically changing the way that patients are listed and managed and moving away from a single provider held model can be challenging however Attain has extensive experience in supporting each stage of this process. We base service design and implementation on robust data and modelling, a clear delivery approach and a governance culture which takes into account the potential short-term impact on organisational and system performance. We also understand that strong clinical and stakeholder engagement, facilitating a clinical focus on solution design, are key to effective delivery; alongside building a system-wide culture that supports the embedding of effective working relationships from the front line through to executive level.

As a starting point for assuring that systems have a solid foundation on which to build, Attain has developed a system integration assessment matrix and we would be more than happy to arrange a call to work through this with you. If you would like more details about this or how we can support you, contact Ian Triplow at ian.triplow@attain.co.uk

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