In early July, the Q insight team ran two research sessions with 14 Q members to explore the issues and challenges connected to backlogs and waiting times for health and care services.
These are pressing issues for many of us – whether you are working in a health and care setting that is under significant pressure, are waiting for treatment, or need to access information and support.
Many commentators and senior leaders are calling for innovation and transformation. But given the scale of the challenge and the intense focus on waiting time targets, we heard that it can feel like a near-impossible task to find the space and energy for such radical change.
We know many organisations are doing great work to share learning and illuminate the challenges on this topic, from third sector organisations like National Voices and Versus Arthritis, to NHS-led initiatives with accelerator sites and the elective recovery fund. However, we also heard a desire from members to ‘pull this into an improvement space’ (to use the words of one participant). For us this means:
- how improvement can be used to ensure the problems and potential solutions are considered systematically and holistically;
- to have space and inspiration to think laterally about the solutions; and
- to provide a sense of purpose, motivation and energy for change that is co-owned and co-designed by patients and professionals across the system.
Based on what we’re hearing from members, we know this isn’t easy. This blog summarises what we heard during the sessions, drawing out five considerations when approaching this work. In order to support Q members and others to respond to these challenges, we want to hear from you so that we can share practical learning and insights on promising solutions. Find out more about how you can get involved and help other members by sharing your work at the end of this blog.
1. We should reframe the issue
We heard from participants that the language used to describe this topic matters. The number of people waiting to access treatment and support from health and care services is higher than it’s ever been. But the words ‘backlogs’ and ‘waiting lists’ can play into a narrow focus on numbers, which may make it harder to secure positive engagement to meet aspirations for timely, high-quality care that is sustainable. Participants’ experiences suggest that we should use language that helps us to better understand what’s at the heart of the demand and capacity issues, and what change is needed to improve access to care, at the right place and the right time.
“If we continue to be deficit based, it’s just going to seem like a huge, huge mountain”
2. We’re tackling a deep-rooted problem
While recent media and political attention understandably focuses on lengthening waiting lists throughout the pandemic, members reminded us that long waiting lists are not new. Our participants reiterated the importance of addressing the deep-seated nature of the issues.
While appreciating that services need to help people immediately waiting for support, and there will be a pull towards short-term fixes to do this, participants conveyed how vital it is to invest in more sustainable solutions that tackle the causes and not just the waiting lists themselves. This requires a greater focus on prevention and early intervention – from looking upstream along care pathways to support alternatives to hospital care, to increasing place-based and pathway-specific collaboration to ensure we address inequalities and the wider determinants of health.
“We’re always focusing on the people at the front door – and expecting staff to work harder to deal with this”
3. We need to prioritise staff health, wellbeing and support
The pandemic has taken a huge toll on staff. Working in a challenging, sometimes traumatising, environment, many are exhausted and burnt out. Members observed how this has affected staff capacity to find solutions.
“Staff fatigue and tiredness just doesn’t allow for creativity. It doesn’t allow them to see beyond what they need to do. Most staff are [just] surviving their shift”
We also heard how staff don’t feel fully equipped to make decisions. Participants described their concerns about the ‘overwhelming numbers’ of people waiting for care. Healthcare teams need to prioritise who to see first, but what we heard suggests that staff often lack decision-making guidance to enable this. This creates ethical dilemmas that add yet more pressure on staff.
4. Data needs to be used to help not hinder
Participants felt data should be at the heart of solutions, but current challenges are presenting barriers for improvers. We heard about missing and poor quality data; incompatible information management systems; lack of access to tools and capabilities to make use of existing data; and a tendency for decision makers to focus on measuring performance against targets rather than ensuring there’s data to guide improvement. The sense from participants is that there is much work needed to change the cultures and capabilities for how to best use data.
“Every innovation we put in is helping our patients, but it’s not helping our figures”
5. Improvement has an important role to play in the solutions
Among the challenges, participants expressed optimism that improvement approaches can offer something much needed and important to improving access to services and addressing backlogs in care. This is not only through technical methods and tools for managing demand and capacity, but also by using improvement skills and approaches to unlock the potential of the people who can jointly create change. Improvers bring skills in facilitation and collaborative working to energise and empower people to make a difference and keep going amid setbacks. In the current context of staff fatigue, this has never been so important.
“I know people are shattered but you know what, I have never seen such enthusiasm for quality improvement in my life”
What do effective solutions look like?
We know there is a lot currently happening across the health and care system to address the challenges of backlogs and long waiting times.
Current solutions we’ve heard about include local collaborations to provide ‘mega clinics’ and surgical hubs; and increased use of virtual wards and virtual consultations, including in group clinics, to ensure people can access support from home. There are also projects that focus on ensuring people are waiting well; increasing implementation of advice and guidance and patient-initiated follow-up, and developing solutions that make better use of data. We heard how improvers are drawing on learning from the vaccine programme, including how to work collaboratively to address inequalities in access to services.
Based on the insights and reflections from Q members we’ve gathered so far, we think it is important to draw out solutions that are helping to sustainably improve access to services by prioritising the following three features:
- Balancing short-term needs and long-term goals
- Making better use of data to support improvement
- Applying systematic improvement tools, methods and approaches to address both the technical and human side of change
Find out more about each of the considerations below.
Are you working on a project to improve access to services that includes these considerations?
In order to support Q members and others to respond to these challenges, we want to hear about the projects you’re working on. Through the projects you share, we will build on the assets and expertise of the Q community to draw out learning that provides practical insights that highlight the work of improvers to help members and others doing this work.
We want to hear more about projects that:
- Are at any stage of development and delivery: from those that are early on or are relatively novel or experimental, to those that have progressed further or have a more fully developed evidence base.
- Haven’t worked as planned: we know there is a lot to learn from solutions that had to significantly change or be abandoned.
How to share your project
Get in touch with us before Tuesday 31 August by either:
- Completing this short form. Please briefly answer as many of the three questions that apply to you (no more than 200 words per question).
- Or contacting Q’s Insight Manager Jo Scott by phone (020 7664 4639) or by email.
We will review the preliminary information and get in touch to explore your project in more detail. We are looking to develop around six detailed case studies to share externally. While we might not feature all examples submitted, everything we hear from you will help to inform what we share to help members.
1. Balancing short-term needs and long-term goals
As we heard from participants, we can’t ignore the immediate pressures health and care services are under. It is important to reduce the number of people waiting and to ensure they are kept informed and are supported to stay well while they wait. But it is not sustainable if this is at the expense of addressing the long-term, deep-rooted issues. We’ve heard convincingly that solutions need to pay attention to staff wellbeing and address existing inequalities, as well as continuing to build trust, shared responsibility and collaboration between settings to make progress.
Briefly describe how you are addressing this challenge. For example:
- How are you prioritising waiting lists? What support/guidance is informing your approach?
- What are you doing to respond in the short-term, while also keeping an eye on long-term demand and capacity challenges?
- What are you doing to improve population health, while also improving quality and outcomes of your services? Does this draw on, for example, the Triple Aim framework, or its development as the ‘quadruple aim’ or ‘quintuple aim’ to take account of the interconnected dimensions of:
- Experience of care
- Health and wellbeing of the population
- Productivity & efficiency
- Addressing inequalities
- Wellbeing of staff
2. Making use of data
We’ve heard that data can be used for more than just measuring performance. By using it to identify issues and variation, data can be the basis of real learning and improvement for solutions.
Briefly describe how you are addressing the quality and application of data. For example:
- How are you making use of existing data? What tools are you using, and how are you increasing analytical capability?
- What evaluation challenges or concerns do you have? What are you currently doing to address these?
- How are you working with commissioners and others to ensure the right questions are being asked, to reframe conversations about targets and outputs to ensure you are measuring what matters, and reporting what counts?
3. Appling improvement tools, methods, and approaches
We’re interested in increasing understanding of how improvement can add value to addressing the issues around waiting times and backlogs in care. This includes both the systematic and technical approaches that provide ‘ways in’ to diagnosing problems and embarking on tests of change; and its value for taking an appreciative stance and awareness of the human side of change.
Briefly describe how improvement is shaping your approach.
- How are you ensuring those closest to the problem are involved in the solution?
- How are you involving patients, the public and staff to shape the changes needed?
- How are you developing the improvement skills and capabilities at all levels of the organisation?
- Which specific methods and tools are you drawing on? These may include the specific methods designed for waiting list reduction, and managing the technical aspects of balancing demand and capacity.