We know that improvement approaches and tools can reduce inequities, but not without making that aim deliberate and specific within your work.
That’s why, together with NHS Providers, we’ve been delivering a programme of peer learning for senior leaders on how provider collaboratives can develop shared improvement approaches – with an equity lens embedded from the outset.
Across 2023, as part of Provider collaboratives: Improving equitably, we ran a series of webinars where people shared their lessons from putting equity at the heart of their improvement programmes
Our third of the series looked at a crucial topic, which is also a priority issue for the Health Foundation and Q, Improving waiting lists equitably.
In the Health Foundation’s article, “How can the next government improve hospital waits in England?” it identified significant variation in waiting times across the UK, with access to in patient care reduced in the most deprived parts of the country. This is just one of many inequities and challenges for those stuck waiting.
Thankfully there is a lot of great work happening to make change. We had three excellent speakers who each put forward actions to design pathways which support patients to wait well, reduce waiting lists, and put equity first.
- Taking an inclusive approach to tackling the elective care backlog
Ruth Robertson, Senior Fellow, The Kings Fund
In 2020 NHS England asked trusts to take an inclusive approach to recovering services post-pandemic. The King’s Fund undertook several qualitative case studies with organisations, analysing what was working well and where there were challenges. They came up with some key recommendations for boards and leaders.
- Proactively engage board members, clinicians, operational leads, and communities in the shared vision for inclusive recovery, using local data to make the case. The vision gets everyone on board for making change.
- Develop a quality data source to explore inequalities and bring together stakeholders to discuss, analyse and agree what the data is telling you. This is the starting point to making changes.
- Once inequalities have been identified, it’s vital to work with local communities to move beyond numbers and understand why inequalities exist and how you can address them. You should consider how your changes can be integrated into core operational processes and be considered part of business as usual.
- Share best practice across partners. Share the evidence and stories of how tackling inequalities can also drive more efficient ways of working and save resources.
- Improving Waitlists Equitably
Russell Nightingale Chief Operating Officer Harrogate and District NHS Foundation Trust and West Yorkshire Association of Acute Trusts
Russell joined to talk about how West Yorkshire Association of Acute Trusts (WYAAT) have put these concepts into practice and how introducing an equity lens has supported tackling their elective waitlist.
- Starting change around behaviour and culture. This meant committing to being in this together and collaborating to make changes as a team: if one fails, all fail. And underpinning that: radical candour, creating “bullshit-free zones” where people love their work and working together.
- Set out a consistent approach to prioritisation within waiting lists across their provider collaborative, to make sure patients receive equity of access to care, regardless of their location.
- Introducing quick improvements: a passport for staff in hospitals so rather than always moving patients they were moving clinicians; designing a new call script for patient transfers; setting up a fund to support patients moving hospitals which removed money as a barrier.
- Embedding a learning and doing approach, asking as a team, “who can we make a difference for quickly?” and then, “are we doing enough?
- Waiting Well
Chris McCann, Director of Communications, Campaigns and Insight, Healthwatch
“It’s not just about the length of the wait but the quality of the wait and how an individual experiences it – and the way to understand this is through communication.”
- Chris McCann shared the insights from their work at Healthwatch on patients’ needs when it comes to waiting well.
- Put systems in place which assess and consider waiting lists from an inequalities perspective. A focus on prioritising urgent treatment for those who routinely experience unequal delays can help tackle these systemic inequities.
- Make sure the patient perspective is central to your thinking. It is important to understand that the quality of a patient’s experience of waiting for care is almost as important as how long they need to wait. Patients often understand the realities of waiting times for elective care and are aware that there may be substantial delays, but it is a sense of uncertainty and lack of communication that causes more stress.
- Develop interim support measures such as physiotherapy, pain relief and mental health support and giving clear information on how to access these interventions could help patients manage their own health whilst waiting for treatment and prevent them from getting worse.
- Provide adequate administrative capacity to support patient contact, and make sure that the staff in those roles receive the correct training in how to relate to and relay information to patients. This can help patients feel supported and understood whilst they wait for care.
In 2023, the Q community also funded improvement projects that would reduce delays, sustainably and equitably. Our recent view of the mid-project reports echo and confirm the same themes we heard from our guest speakers from provider collaboratives – the importance of co-design with patients and collaboration across clinical boundaries.
For example, Waiting As Well As Possible is seeking to understand what people who are waiting for psychological care in South Wales would find most useful to help them to wait well. Building on an existing community of practice, the team is made up of those with lived experience, clinical expertise, partner agencies, and the local health board.
If you’d like to enjoy the full recording of this session, it is available to watch on the Provider Collaboratives: Improving Equitably webpage.
You can also watch all the webinar recordings from our partnership’s six-part series on improving equitably, or read summaries of the sessions on the NHS Providers’ site. You can learn more about Q Exchange, the Q funding programme on our website.
