Moving past backlogs and waiting times

The huge pressures around access to care in the UK and Ireland are well documented. Challenges include record-high waiting lists for elective care, [ref]Blythe N, Ross S. ​‘Strategies to reduce waiting times for elective care’ 2022[/ref] large hidden waits, and barriers to accessing care across many parts of the system.[ref]The Community Network. Hidden waits. The last impact of the pandemic on children’s services in the community. 2022[/ref][ref]BMA. NHS backlog data analysis. [cited April 2023] [/​ref]

Addressing these issues is an urgent system priority and an area where the skills and mindsets of those working to improve health and care are valuable in developing solutions. In July 2021 we spoke with a group of Q members to explore the challenges for people working to address backlogs and improve access to services. They told us they wanted to hear and learn from what others were doing, specifically around how to:

• balance short-term needs and long-term goals
• make better use of data to support improvements
• apply systematic improvement tools, methods and approaches to address both the technical and human side of change.

We worked collaboratively with members to identify and capture six case studies that touch on the important areas of learning cited by members. All of the case studies involve improvement projects to address challenges with backlogs in care. You can find them further down this page.

During the case study interviews, common issues of collection, analysis and use of data were raised as barriers to progress.[ref]Read more about what members told us during the interviews, in a blog post by Henry Cann and Jo Scott: Moving past backlogs: insights from improvers.[/​ref] This led to a second insight project to hear from people who are confronting data challenges directly in their improvement work on backlogs and access. Here we used an action learning approach: bringing peers together to explore live issues.

We published the findings of the action learning project in a report in April 2023. Explore the report’s insights into the key factors needed to make progress in using data to address backlogs and access in your organisation.

1. Acting with urgency but recognising the need for a longer-term focus. This includes being clear on the trade-offs between efficiency and equity and balancing immediate action with more deep-rooted change.
2. Collecting and accessing better data on waiting lists and inequalities. This means drawing on national data where possible, but also investing in foundational data collection at a project level.
3. Turning often imperfect data into action. The project highlighted the need to recognise the psychological toll and anxiety that working with imperfect data can cause. Also the time, capabilities, infrastructure and data literacy required to act on data.
4. Recognising the benefits, and limitations, of applying a systematic improvement approach. Improvement can play an important role in defining priorities and problems, engaging staff, and co-producing with patients. But those working in quality improvement need to apply much greater focus to developing tools and methods that directly support equity and equality.
5. Collaborating with and learning from others. We need to create spaces and processes where people working with data to improve access can share challenges and solutions.

During the project we published the emerging insights in two interim reports.[ref]The Q Community. Moving past backlogs: how can a focus on data help to ensure equitable access to services? (Emerging insights part 1). July 2022[/ref][ref]The Q Community. Moving past backlogs: how can a focus on data help to ensure equitable access to services? (Emerging insights part 2). September 2022[/ref]