Recovery Watch: A new data burden for trusts. But will it help?

Acute trusts from today (14 April) are due to report into a new elective weekly data collection, which NHS England and Improvement says will “provide a timely view of the waiting list across the country”.

NHSE/I announced the significant new reporting duty — called the waiting list minimum dataset — in a letter last month (attached).

The body’s performance tzar Pauline Philip said in the letter: “The new MDS will provide a much richer set of information than the existing weekly referral to treatment patient tracking list, including detail of procedures patients are waiting for and clinical priority (P-code). 

“Over the coming weeks we will be creating further resources and webinars to support the transition to the new waiting list MDS, including the development of a dashboard tool that systems, regions and providers will be able to access.”

Reaction to the new data ask was mixed. Some trust sources were not convinced the significant additional burden would be worth the candle and questioned why it had been foisted upon providers with little in the way of formal consultation.

Others viewed the new collection as a means to help manage data at an integrated care system level, help local systems equalise waiting times and track the elective incentive scheme.

These included Glen Burley, an influential provider figure who is chief executive of three Midlands trusts — George Eliot Hospital Trust, South Warwickshire Foundation Trust and Wye Valley Trust. However, he warned: “Managing data at such a level is pretty much uncharted territory. Probably the biggest issue with the weekly returns will be data quality as most validation routines are currently monthly.”

He added there may need to be an acceptance, as there always has been with contracting data, that provisional data is open to formal confirmation and signoff further downstream.

A big burden — for clinicians as well as analysts?

But others were less welcoming towards the new collection. They raised concerns about the additional burdens on trusts’ analytical capacity in gathering a range of extra data they currently don’t collect.

Moreover, the guidance also sets out plans, which are not live yet but could be in future, for the clinical prioritisation of outpatient and diagnostics, similar to that carried out for admitted patients at present.

One senior figure said: “Having consultants grade the admitted list as priority 1 to priority 6 [the so-called ‘P catagorisation’] was a massive piece of work.

“But the outpatient list is much larger and there’s less information to go on. Clinicians will spend so much time prioritising the outpatients, that it will take them away from the clinical work of actually dealing with the problem.”

The well-regarded source said while this was not yet being asked of providers, there were concerns about the harm-benefit ratio of such an ask should it be made in future.

Holding providers to account

Long-time waiting list watcher Rob Findlay was among those who was unclear as to what the underlying drivers were for the switch to a new collection. He told me collecting information about overdue urgent and follow-up patients was a good idea, as was collecting the data at patient level using automated data feeds.

But he added: “The required data is much more extensive than that, and it attempts to capture non-RTT patients using the language of RTT which is going to cause confusion. So I am wondering: what is the purpose of this very large and specific data collection, and who is it intended to benefit?

“The data on patients as they flow through the waiting list is too limited for capacity planning purposes, suggesting that the purpose of this data collection may be more about holding providers to account and targeting individual named patients for treatment, than about improving the management of elective care as a system.”

Holding providers to account will, of course, still be an important function, even as the NHS evolves into the ICS world and a greater focus on system-level performance.

However, NHS Providers warned it would be “seeking assurances that the data will be used to support colleagues at the frontline, who are doing their best to reduce waiting lists in challenging circumstances”.

“We must also be realistic about how long it is going to take, and how challenging it will be due to the various factors at play, to reduce waiting lists,” added NHSP director of policy and strategy Miriam Deakin.

There is no doubt significant improvements to data collections to ensure local and national system leaders can get a better handle on local waiting list issues can and should be made.

But while it may be too early to judge how much impact the new waiting list MDS will have, it certainly feels to those on the ground who I spoke to that a more consultative approach to future changes in how this crucial data is collected would be more constructive.