“Going beyond clinical nous” - how can we use data to more fairly prioritise community services?
The PSC and Sussex Community NHS Foundation Trust (SCFT) hosted a roundtable to discuss how data can help prioritise limited community resources and deliver on the 2022/23 operational planning guidance for community health services
Community health services are critical to making health and care more patient-centric and sustainable over the long term. The NHS Long Term Plan has stated a goal to shift more care out of hospitals and into community – closer to where people live.
Changing NHS legislation and a challenging funding landscape mean that it is more important than ever that community healthcare trusts are supported to get the most out of the limited resources available to them.
The recently published “2022/23 Priorities and Operational Planning Guidance” also lays out some ambitious goals for community services waiting lists:
prioritise patients on waiting lists
develop a trajectory for reducing their community service waiting lists and significantly reduce the number of patients waiting for community services
consider transforming service pathways and models to improve effectiveness and productivity.
In this article we highlight how we have supported SCFT’s Standardised Waiting Times Project to address these goals, alongside insights from a recent roundtable that brought together health and care leaders from across the country to discuss how they could use data to prioritise limited community services resources in a fairer way based on patient needs.
Prioritise patients on waiting lists
“Prioritisation is really hard because there are often few obvious parameters to base judgements on, and these parameters are hard to unpick.”
In the context of scarce resources and increasing demand, deciding fairly on how to prioritise treatment for patients on waiting lists is notoriously difficult. Factor in the disruption to all non-emergency care caused by the Covid-19 pandemic, and this becomes an even more fraught exercise.
Clinical judgement goes a long way in making effective prioritisation decisions and should always be an important part of the picture. But relying on clinical judgement alone risks decision-making that is based on a narrow set of parameters, subject to variation amongst individual clinicians, and inadvertently leading unequal provision of services.
Furthermore, the data that you need to prioritise patients can often be of a poor quality in community services and they are not usually covered by national reporting processes in the same way as they are for acute services. As a result, the limited data that exists is often held at a very local level, sometimes with little corporate oversight.
A more standardised, data-driven approach makes comparison between patients fairer, and makes it easier to justify prioritisation decisions with patients and their families.
To get there, The PSC supported SCFT in establishing the Standardised Waiting Times Matrix – a tool that helps teams put the risk of potential harm to patients caused by delays to their care at the forefront of decision-making regarding patient prioritisation. The tool, a simple collaboratively-developed matrix, sets out in a standardised way, the potential harm for patients across a range of services, whilst still leaving flexibility for clinicians to exercise their own judgement too.
Key to this work was establishing a Trust-wide set of maximum waiting times at different points of a patient’s care pathway, differentiated by four generic patient cohorts. These cohorts were based on the risk of clinical harm associated with delays in a patient’s care – ranging from severe risk to low risk. The maximum waiting times were bounded by national equivalent standards where applicable and informed by expert clinical input. Individual services piloting this methodology were able to map their service-specific patient groupings across to these four generic cohorts, to arrive at the maximum waiting times applicable to their service.
Senior clinical leaders at SCFT developed five core principles to guide this work. They agreed that the standardised maximum waiting times should:
Aspire to reducing risk of clinical harm and not be swayed by current operational constraints
Address the most important clinically relevant stages of the end-to-end pathway for which patients are waiting
Not dictate the clinical prioritisation of individual patients; but rather serve as a proactive indicator of emerging clinical risks – for clinicians and managers to then act on
Support parity between consultant-led and non-consultant-led services
Be as easy as possible to report on and interpret
Develop a trajectory for reducing their community service waiting lists and significantly reduce the number of patients waiting for community services
Gathering the data on and then prioritising patients on waiting lists is the first step in helping services to develop trajectories for reducing their waiting lists. And the Standardised Waiting Times Matrix helps services to do just that.
The Matrix will help teams to take a holistic view of the patients on their waiting lists while being able to segment and prioritise them based on the risk of clinical harm that may be caused by further waits.
The second and key part of the work that SCFT and The PSC are doing as part of the Standardised Waiting Times Project, is to then use these insights and work with services and internal Quality Improvement teams to co-author Standard Operating Procedures that will help them to reduce their waiting lists in a sustainable and realistic way.
Consider transforming service pathways and models to improve effectiveness and productivity
The third phase of the Standardised Waiting Times Project is to learn from the experiences of our colleagues on the frontline of services in order to understand how we can support them to transform their service pathways and processes with an aim to helping them get the most of the limited resources they have been given.
By performing standardised team capacity reviews and facilitating process mapping of the services across the often large areas they serve, we will help service teams to have a better view of the overarching service. This will then act as a springboard to gather the ideas of service teams on how they can transform their services to more effectively deal with their waiting lists and improve the service as a whole. Agile project deployment has meant that we have already found opportunity to learn by listening to colleagues on the frontline, standardise, and continuously improve this process.
To leave the final word to one of our roundtable participants:
“We can absolutely use data more smartly to join up care and to maximise the impact of community services. We have so much to offer as a sector to improve health outcomes for our populations, and support systems to use resources better.”
Harris Lorie and Arup Nath, The PSC Transformation Team
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