Trust to move people with learning disabilities up waiting lists

The decision forms part of wider analysis at Calderdale and Huddersfield Foundation Trust of how the impact of covid, and work to recover from it, can exacerbate health inequalities and how this can be addressed.

The FT said in a board paper it would “initially prioritise [people with a learning disability] for treatment after cancer and urgent patients”.

Papers said it wanted to prioritise patients “around health inequalities and need based” rather than chronologically, as part of its covid elective recovery work.

It made the decision about people with a learning disability as they have a shorter average life expectancy “and therefore the impact of waiting for treatment can both further reduce this as well as disproportionately impact on their quality of life whilst waiting,” according to trust board papers.

CHFT, in west Yorkshire, said it clinically prioritised 66 patients on its waiting lists who had learning disabilities and would otherwise have been treated in chronological order with other patients. It would hold dedicated theatre sessions which “put primacy on the learning disability need before clinical speciality”, it said.

Board papers added early analysis by the trust had also found “unexplained variation” in waiting times for surgery between different ethnic groups.

CHFT’s performance management and accountability framework, published last month, said it would use health inequalities data to inform clinical prioritisation.

The framework, written by Peter Keogh, the trust’s assistant director of performance, said: “By reviewing the waiting list data we have been able to look more holistically at patient groups and individuals with a view to moving away from the traditional urgency profile, then chronological dating of patients to one where we may want to prioritise based on different risks factors.

“The two areas currently in focus are patients with a learning disability and patients from a BAME background.”

HSJ understands CHFT has also examined wealth inequalities and found those who are poorer are waiting longer, something also demonstrated in other recent analysis.

More details of the CHFT findings have been discussed among NHS leaders in the region and more widely, several senior sources told HSJ. However, the trust does not yet want to share them publicly.

Similar work is being carried out in the West Yorkshire integrated care system, including on learning disabilities; while NHS England planning guidance requires systems to “use their data to plan the inclusive restoration of services… informed by NHS performance reports that are delineated by ethnicity and deprivation”.

The CHFT work does not appear to identify reasons for the variation, but several NHS leaders in the region who had discussed it cited issues including the tendency to seek and push for quicker appointments and referrals; unconscious bias in treatment decisions and processes; and prioritisation of some treatments/specialties which are more common among some particular groups.

CHFT’s chief executive, Owen Williams, was made chair of an NHSE health inequalities expert advisory group chair last year amid outcry about the impact of covid. One of its recommendations in August was for ”monthly NHS reporting [to] in future include measures of performance in relation to patients from the 20 per cent most deprived neighbourhoods… as well as those from Black and Asian communities where data is available”, with progress to be made by October. This work has not yet been published.

Calderdale and Huddersfield FT was contacted for further comment.