Tackling waits in the health system is a priority for Q and our members, as it is for the health service. Q and the Health Foundation are funding projects working on waits through Q Exchange and looking towards the launch on 11 May of the latest Q Lab, which will focus on reducing delays in elective pathways.

So we were very pleased that Sir Jim Mackey could talk to me about what the NHS is doing in England to tackle delays – what’s going well, where the challenges are and how the improvement community can help meet them. There is no one better placed to tell us about this, as Chief Executive of Northumbria Healthcare NHS Foundation Trust and NHS England (NHSE) National Director of Elective Recovery.*

Penny: Why is tackling waits so important?

Jim: It is vitally important because timely care is a fundamental part of quality. Long waits are really worrying the public and worrying our clinical communities; worrying all of us. Waiting has consequences, causing psychological as well as physical harm. Let’s just remember, it’s part of quality for a reason.

Penny: Where are we at in terms of progress on elective recovery? How have we got here and what was the role of improvement?

Jim: The elective recovery plan set out various priorities and steps, with a strong focus on reducing very long waits. NHSE will soon be publishing our position against the target of virtually eliminating waits of over 78 weeks. Before Christmas, nationally we peaked at around 125,000 people waiting this long. It reduced down and was at about 50,000 people for several weeks, before a challenging winter, with industrial action, flu, etc. In spite of that, these numbers began falling steadily.

We did this by doing the basics well. In January, we asked that everybody on elective waiting lists should be booked in before the end of March – not see them, but just give them a date. This flushed out an awful lot of noise and bad data: people who didn’t want to be treated, people who’d been treated elsewhere, etc. And it got better. It gave everyone a bit of confidence. And it showed that, when you break it down, for most clinicians, it’s not seeing 6,000 patients, it’s seeing, say, 60. So it is much more manageable and realistic.

From an improvement perspective there’s learning in this about celebrating and doing the basics well. Not just doing them, but doing them in a collaborative way.

Actually relearning how to book patients in and prioritise appropriately, how you engage with people, how you have conversations with patients. There’s a lot in that which is positive and learnable, and scalable into other things.

Penny: What could the improvement community learn from this and do to help sustain what’s been working well?

Jim: In Northumbria, we’re in the process of refreshing our improvement approach and getting ready for the post-COVID world: we’ve already reduced waits in gastroenterology from four months to four weeks.

I think it’s still the case that improvement feels inaccessible to some. It feels different to doing their job and doing the basics well. There’s something to be done about how we bridge the gap, showing that improvement and day-to-day delivery are all intertwined and must pull together again. Improvement shouldn’t feel too complicated or inaccessible and, yes, to me it is really about doing the little, single things well.

Then there’s something about translating and adapting improvement approaches to an in-flight model, because nobody can down tools for a month and unpack end-to-end pathways. I know nobody’s saying this, but it feels like that at times. When that’s the perception, it fuels the idea that we don’t have time to apply improvement approaches to these problems because there’s an urgency about preventing people being harmed by delays in treatment.

The use of data and psychology in all of this are the big standouts for me.

Improvement is data-driven: using the facts and testing what people say is happening, rather than relying on what you think is happening. The power of learning from data and tracking progress is also important – it helps people feel like they’ve achieved something, builds confidence and gathers momentum. So it speaks to the psychological component: getting people engaged on the task.

Penny: What difference do you think the rollout of NHS Impact, the new single shared improvement approach, could make?

Jim: The approach is such an important initiative, building on the Long Term Plan. It will help embed improvement across the system and realise the potential to drive major and sustained change.

It should help to clarify improvement’s role, which I think is necessary – and help everyone understand their role and encourage buy in.

That said, it has been launched at a time when the NHS faces wide ranging pressures, and the workforce is under strain. We have to be realistic about the capacity that leaders and other staff will have to realise the potential of NHS Impact.

That’s why it sets out broad components rather than a fixed way of doing things. These give leaders the chance to prioritise and handle some of the immediate priorities, while putting in place the practice and culture that will sustain long-term improvement.

Penny: Q Lab UK is one of the programmes we run to help people tackle complex health care challenges, jointly funded by the Health Foundation and NHSE. Our Lab starting in May will work on how we can create collective responsibility to reduce delays in elective pathways. What’s the potential for this to support the next stage of elective recovery?

Jim: This is great and timely. We are getting over the year end, and are focused on having a good start to 2023/24: this includes learning what’s worked in these last few months, and applying it to the next task on outpatient transformation.

The next stage involves proper improvement stuff, where it gets complicated: it’s a lot of moving parts and people need to go about it well.

So, we’re going to have to get people engaged in the process of thinking about how we work collaboratively to address these issues.

There’s a lot of value in people understanding what others have done. Sharing learning benefits teams. Let’s celebrate what we have learned and continue to contribute to a big push on reducing delays.

* This Q&A took place before the announcement in May that Sir Jim Mackey would lead NHSE’s Chief Operating Officer directorate for an interim period after Sir David Sloman retires in September.

New Q Lab UK project: reducing waits in elective care

We have now launched our latest Lab project on this important topic. Find out more about the topic, the Lab approach and how you can get involved.