Shared patient waiting lists: How to manage NHS capacity as a system

With growing backlogs of patients waiting for surgery, the NHS must quickly grapple with how to treat those patients, writes Ashley MacNaughton and David Thorpe

Covid-19 has had a profound impact on the NHS’ ability to deliver healthcare. NHS waiting lists are at their highest level since 2008, so hospitals need to quickly find ways to maximise the utilisation of available capacity without compromising patient outcomes and experience.

To support efforts to optimise utilisation in the wake of the pandemic, the NHS renewed its guidance on integrated care systems in January 2021, asking trusts to collaborate and share patients where appropriate. But while NHS hospitals routinely ‘share’ non-elective patients to manage pressures on bed capacity (especially during winter), it is less common in elective care. This is unsurprising due to the frequent lack of dynamic, real-time and usable data to support agile decision making with regards to hospitals’ elective activity and capacity.

Too often, hospitals see sharing a patient waiting list as a sign of failure – an inability to effectively plan and manage their own resources. But this perception has prevented the NHS from taking advantage of its economies of scale to maximise its resources while delivering cost-effective and high-quality outcomes.

To overcome this and fast track elective recovery post-Covid-19, the NHS needs to digitalise a shared patient waiting list.

What is a shared patient waiting list?
A shared patient waiting list must be more than just a combination of Patient Tracking Lists (PTLs) from multiple trusts. It requires an easily accessible digital platform containing all relevant information about patients. This ensures that anyone managing the treatment of elective patients can make a fully informed decision, not only to make best use of upcoming capacity, but also to achieve the best outcomes for the patient.

How can the NHS implement a shared patient waiting list?
In our experience, there are five key requirements to make shared patient waiting lists a success:

•    Align vision, deliverables and goals
Collaborating to deliver patient care across multiple organisations isn’t straightforward. But the motivation for doing so is to treat all patients as quickly as possible in the most cost-effective way while achieving the best possible outcomes. By adopting clear, functional and jointly agreed metrics to guide decision making and objectively measure success, organisations can embrace the benefits of sharing their waiting lists. For example, having clearly defined metrics to measure whether patients are being treated in priority order will enable all participating organisations to manage, engage and reassure their teams effectively. Supplementing this through inclusive governance forums to transparently review progress, evaluate decisions and reflect on whether the sharing of waiting lists is having the impact expected, will also serve to maximise this.

•    Incentivise collaboration
The financial stability of acute Trusts often relies on their ability to treat elective patients efficiently, as do several key performance metrics such as Referral to Treatment waiting times. This is true whether they are commissioned via Payment by Results (PbR) contracts or block contracts. Often, organising additional sessions at a premium staffing rate is a more cost-effective way of managing long waiting lists than sending patients to other providers. Establishing system-level performance management to reward those working collaboratively is vital to improving access to high quality care for the greatest number of patients. By looking at innovative payment mechanisms which are linked to low waiting times or costs per operation across the system, Trusts can be supported to move from focusing on balancing their books to maximising the utilisation of their available resources. 

•    Devolve governance to the system
Sharing patient waiting lists means the performance of individual organisations can sometimes come second to the greater good. If a single provider leads the governance model, they’ll find it difficult to remain impartial and altruistic, especially when making difficult decisions that adversely affect their organisations and surgeons. Devolving governance to either a Provider Collaborative or an Integrated Care System (ICS) governing body mitigates any conflicts by making the leadership agnostic to organisational finances and performance metrics.

•    ‘Pull’ patients to where there’s capacity
Too often, shared waiting lists result in hospitals with limited capacity sending patients to other providers at short notice. This puts more pressure on the receiving organisations, disincentivising collaborative working and resulting in a poor patient experience. Rather than hospitals with capacity waiting for other hospitals to send them patients to treat, sharing waiting lists will mean that they can proactively identify where there are suitable patients to fill their upcoming capacity. By creating an operating model in which hospitals ‘pull’ patients on the waiting list when they have capacity, they can maximise their productivity and build long term partnerships without negatively impacting their performance metrics.

•    Embrace digital
Sharing patient waiting lists needs to be more than a spreadsheet. Every patient, operation, surgeon and hospital is different – and the risk with sharing patient waiting lists is that this is lost, leading to improved productivity at the expense of high-quality patient outcomes. Therefore, it is crucial that decisions on which patients to share, which surgeon to share with and what hospital to operate from is evidence based and fully informed, with the data to back it up. The solution must be dynamic, real-time and customisable to complement individual teams, their booking processes and their ways of working. Without this, efforts to share patient waiting lists will continue to be underwhelming.

The NHS must embrace shared patient waiting lists
Shared waiting lists can be difficult to manage and overall, there is a lack of real incentive for an already exhausted hospital in the midst of the Covid-19 recovery. But by focusing on shared aims, incentivising collaboration, devolving governance, shifting the operating model, and embracing digital, the NHS can successfully design, implement and embed them effectively. System leaders need to build on the heroic response to the pandemic and make that level of collaboration and partnership the blueprint for how the NHS operates on a day-to-day basis. Now is the time to be brave and embed shared waiting lists to improve access and choice for patients and help clear the NHS backlog.

Ashley MacNaughton and David Thorpe are healthcare experts at PA Consulting.