Improving systems, seeking proactive assurance on digital infrastructures and upskilling the workforce are key to tackling the backlog in the here and now to keep patients safe, says Stephen Hall

Despite cutting waiting lists being one of the prime minister’s five key pledges, there are no signs of these numbers falling anytime soon and this cannot be laid at the door of recent events alone.

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The narrative is well rehearsed: even before the pandemic, NHS elective waiting lists were growing as a result of steadily increasing demand for elective services unaddressed with matching capacity. Then the covid-19 pandemic, followed by the industrial action this year, restricted activity further and saw elective waiting lists grow to an all-time high of 7.4 million (as of June 2023) people waiting for treatment.

It follows, therefore, that the solution is to respond to these all too obvious symptoms in front of us, all 7.4 million of them. Should it be defined wholly by the recovery of activity? Not entirely. Accepting these demand and supply issues, the present stubbornness of the high waiting list figures also reveal some of the challenges NHS trusts face with the actual management of the patient waiting lists themselves.

Two factors stand out: first, the suitability of the systems and infrastructure we use for the management of patient waiting lists and second, a lack of investment in the workforce that we look towards to administer waiting lists on a day-to-day basis. Neither of these are immediately the result of the unprecedented external pressures although those events should undoubtedly bring them into increasingly sharper focus.

Bringing systems and infrastructure up to speed

The systems and infrastructures that support waiting list management include IT, specific tools for proactive patient tracking, as well as the processes that staff follow to efficiently and accurately coordinate pathways for patients waiting on lists.

Many trusts waste millions of hours of clinicians’ time due to inadequate IT systems. A recent British Medical Association report found that four in five doctors believe that improving IT infrastructure and digital technology would have a positive impact in tackling backlogs. The report goes on to say nearly three quarters of doctors would prioritise bringing software up to date.

Additionally, in recent months we have seen real-life examples of outdated digital infrastructure resulting in patients being wrongly removed from waiting lists and potentially missing out on treatment. These serious incidents pose a very significant risk to patients especially in the context of ever growing waiting lists.

At Acumentice, we are often invited to support NHS organisations where such an incident has taken place. Invariably, there is need for rapid recovery planning whilst building strong and secure elective waiting list management systems and processes. The impacts of these issues on patient safety is also paramount. Incidents of poor data quality, including the “loss” of waiting list records, are due to a variety of variables and not only lead to patient safety issues but require a greater investment of time and resources after they have failed and need to be recovered.

There is an argument, therefore, for investment in early assurance and safety nets built by experts in data and waiting list reporting infrastructures within elective care. Proactive assurance and governance structures are what NHS leaders and Trust boards can then rely on to keep patients safe whilst their organisations manage double the patients on waiting lists with, in many cases, the same number of staff as before.

Upskilling the workforce on the fundamentals

While we know that a lack of up-to-date IT/digital solutions and workforce shortages are live issues, there are plans and solutions to resolve these (albeit none of these are quick fixes). However, the thread that ties all this together is the people working behind the scenes who manage these waiting lists such as the pathway coordinators and managers.

There is a huge focus, and rightly so, on the rising demand and the clinical workforce required to serve it but we cannot ignore the administrators essential to safely manage the waiting lists in their current state. Indeed, it is crucial for managers in the NHS to be adequately trained, especially in the subject of waiting list management fundamentals. Despite this, an independent review of health and adult social care leadership by Sir Gordon Messenger found that there is a lack of equal opportunities for managers to access training, compared to other staff groups.

I recall managing waiting lists when I was a front line manager in the NHS and I did so effectively, only with the support of multiple colleagues who had the expertise to share with me rather than formal training. There is, therefore, a real need for focussed training which is engaging and effective to support colleagues through this challenge. Acumentice have created high specification development materials together with colleagues from the NHS frontline in order to start moving the dial on this issue.

While there are clear challenges when it comes to effectively conquering the size of current elective care waiting lists, the importance of getting all the supporting factors right at the same time as providers push for additional activity cannot be underestimated.

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