It is imperative that we think now about how we prioritise our patients and deliver timely care to maximise safety and minimise risk, writes Doug Treanor
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As we begin to look forward to a return to normality over the summer for our day-to-day activities, the NHS is busy preparing its largest ever recovery programme. For that undertaking to be as successful as the recent vaccination programme, it will need to be underpinned by clear, collated, comprehensive data.
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With 388,000 patients waiting more than a year for non-urgent surgery compared with just 1,600 before the pandemic began, it is imperative that we think now about how we prioritise our patients and deliver timely care to maximise safety and minimise risk. This is a unique opportunity for the NHS to evolve the methodology behind elective care provision based on reliable data to one much more sensitive and practical for patients and providers alike.
Keeping patients safely prioritised
The NHS has already refined the prior clinical urgency classifications of Routine, Urgent and Suspected Cancer to the more sensitive and relevant Clinical Prioritisation system of 1 to 4 used throughout the pandemic for patients awaiting surgical interventions. But not all patients have been prioritised in this manner and many of those that have been prioritised may not be seen for many months due to their lower prioritisation.
How do we provide the appropriate safety net for these patients to protect them from harm? We, at Acumentice, are working with our partners to improve waiting list datasets which are supporting the development of systems for contacting and tracking these patients. This will ensure that worsening symptomology can be quickly identified and escalated to a higher clinical priority where appropriate.
A richer dataset here will also allow targeted analysis of historical waiting times to identify trends and themes we can use to model care delivery moving forward. Clearly, Cancer and Priority 1/2 patients are top of the list when it comes to whom the NHS should focus on first. But it is less clear who should take priority thereafter, especially as the number of ‘long waiters’ has now spiralled into the many thousands for most integrated care systems.
Addressing health inequalities
Furthermore, covid-19 has generated a real impetus to address some of the healthcare inequalities experienced in the NHS. Perhaps there is no better example of this than the requirement in the recent 2021-22 Operational Planning Implementation Guidance to “prioritise service delivery by taking account of the bottom 20% by IMD and BAME populations”.
This is a well-intentioned evolution of the elective care principles which begin to address some of the inequalities that exist within our society, made all too visible by the pandemic. But aligning this data to a waiting list is no easy feat.
How should providers set this requirement against other important metrics such as age or waiting times? These are the questions providers and commissioners should be considering now so they can ensure they have the appropriate datasets to hand as the recovery plans and analysis are designed and delivered. Once again, comprehensive datasets will support the management of waiting lists through these multiple lenses.
Supporting integration and innovation
As ICSs are stood up across the country and shared Patient Tracking Lists start to inform decisions regarding service provision across the system, the need to standardise our datasets has become all the more important.
Maximising local capacity through use of the independent sector or using dedicated Elective Activity Coordination Hubs for lower acuity work are a positive step forward, but for an ICS to fairly treat patients in order, each provider’s waiting lists will need to be reviewable as one. This can be a perilous task if providers are using different patient administration IT systems with different data points.
Here, collating data effectively is paramount. We are working with ICS partners to achieve this by extracting and transforming datasets from different administrative and clinical systems into a standardised format, the foundation of a shared system PTL.
Senior leaders within an ICS must be confident in the accuracy and timeliness of the data if they are to be able to prioritise the patients most at need. Furthermore, by incorporating new data points such as clinical prioritisation and deprivation indices, we can start to create a rich dataset in a digestible format which provides the insights necessary to design new models of elective care delivery for the future.
As elective care recovery is designed at pace across the NHS, maintaining and developing our data quality will provide the strongest foundation for delivering these plans as rapidly and as fairly as possible.
