“Long Overdue”: What issues are Trusts facing?

Colleagues shared some of the challenges they face with managing waiting times. This included the time consuming and manual process currently required to get information on patients who are waiting so that they can be prioritised – it was agreed a solution is "long-overdue.”

Jonathon Artingstall, Associate Director of Information and Performance at CPFT, shared how they navigated a clinical system move during COVID. However, there are still challenges with their waiting time reporting and management and further opportunities for improvement, especially for their mental health services. This includes: 

• Achieving consistency in triaging patients' risk of harm
• Equity of access 
• Increasing efficiency
• Having data to support business cases.

What is the national picture?

Kate Jackson, Assistant Director for Community Services Transformation at NHS England, shared the national community waiting list picture and upcoming guidance. 

Situation Reporting (SitRep) on waiting times shows high numbers of patients on community health service waiting lists for both adults' (predominantly musculoskeletal (MSK) podiatry, and rehabilitation services) and children's services. The high numbers are driven by rising demand, workforce supply issues, poor community data and access, and variation and lack of standardisation in community health service definitions, delivery models and commissioning.

NHS England has put together a data improvement plan alongside a longer-term recovery strategy to reduce waiting times which balances short-term operational pressures with transformational change. 

We also learned that a Community MSK Improvement Framework will be published to support reducing waits and improving outcomes.

Sussex Community Foundation Trust’s approach

Lloyd Barker, Deputy Chief Operations Officer at Sussex Community Foundation Trust (SCFT), shared the approach they’d taken to understand, report on and manage their waiting times.

Driven by gaps in reporting and hidden numbers of patients waiting for services, SCFT were keen to address patients most at risk and see them according to need. They hoped this would have a number of benefits including:

• Improved quality of care
• Equity of access
• Aiding planning
• Bringing teams together.

Supported by The PSC, SCFT developed a waiting times reporting methodology centred around reducing clinical harm. They set maximum waiting times for patients according to their risk of clinical harm for different key waits covering clinically relevant stages from the whole patient pathway.

Through this data collection, they were also able to capture valuable demographic information which allowed them to see performance against waiting times target for different demographic groups, e.g., those from a certain deprivation decile.

The resulting dashboard has been crucial in helping them better understand their waiting times and patients on their waiting lists, enabling prioritisation of patients according to risk of clinical harm.

How can we best share learning on community waiting times?

The group agreed on the need to bring people together. Lloyd Barker shared that SCFT's waiting times reporting took around 6 months from scoping to the first cut of the working model. Elements of this process are transferrable to other organisations, e.g., the methodology of setting maximum waits for different clinical need categories and key waits from across the pathway. However, Lloyd recommended spending time with clinicians to discuss, challenge, and agree on maximum waiting times for services.

Another colleague highlighted the current focus on the first appointment for commissioning of community health services, with gaps in the reporting of time-consuming follow-on aspects of care. Kate Jackson agreed that this subsequently negatively impacts on quality of care and has plans for commissioning guidance to support next steps.

Lloyd Barker raised the need to support people who are waiting to help manage their symptoms such those on the neurodevelopmental pathway who are waiting for a diagnosis. SCFT's new waiting times reporting will allow the organisation to better understand the wider needs and contributing factors for those on the waiting list; developing organisation-wide principles around this is planned for a second phase of work. Lloyd also shared how the new waiting times methodology and reporting helps enable proactive risk stratification of patients as they enter the system rather than a macro view of the caseload as a whole.

Other colleagues from CPFT highlighted the cultural shift required away from the two-dimensional red and green of targets, and the need for place and system alignment on the approach to managing backlogs.

If you’d like to find out more about Sussex Community NHS Foundation Trust’s approach to reduce waiting times, do get in touch with Lloyd Barker at lloydbarker@nhs.net.

And if you’d like to find out more about the roundtable as a whole, please get in contact with The PSC at arup.nath@thepsc.co.uk.