What is the challenge your project is going to address and how does it connect to the theme of 'How can improvement be used to reduce delays accessing health and care services'?

Nationally, children’s waiting times for treatment are the highest they have ever been. Disruption due to COVID-19, centralisation of paediatric surgery and loss of paediatric lists have all been identified as contributory factors.

The national picture is reflected locally; analysis of waiting lists at our organisation show that amongst priority two patients, children under 10 years old had the longest waits for treatment.

Delays to treatment for children have secondary consequences including loss of schooling, financial impact for families with carers missing work and disruption to family life. These effects are often greatest for the most vulnerable children and families.

We want to work with families to understand the impact of waiting on children and their families, co-design pathways in targeted specialities to improve access and trial interventions to support children and their families in waiting well.

This work will feed into the Health Equity programme within the organisation and ICB.

What does your project aim to achieve?

The project has two main aims:
1.    We want to gain insights on the impact of waiting on children and their families with a focus on health equity.
2.    We want to work with families in key clinical areas such as oral health to improve access and support whilst waiting.

Significant inequality in oral health continue to exist and reducing waiting list backlogs in oral health has been identified as a key clinical area for children and young people in Core20Plus5. Understanding how we can support families on this pathway and work with them to reduce DNAs and theatre cancellations will help to reduce both health inequalities and overall waiting time.

The two aspects of the project are synergistic: insights from the wider consultation will help to inform our work with key areas and the learning from co-design with families will help identify health promotion opportunities for families whilst waiting.

core20plus5-cyp-infographic-v2 (PDF)

How will the project be delivered?

A dedicated working group including analytical, clinical, operational and improvement colleagues is already in place and will include representatives from the separate Patient and Public Involvement and Engagement (PPIE) board (see below). Regular reporting to executive via health equity programme.

Establishment of a PPIE board to ensure a strong community voice and inclusive involvement. We will work with our partners in West London Children’s Healthcare and include GP and voluntary sector representation.

Collecting insights from patients and their families about their experience of waiting utilising patient surveys, focus groups and meeting with local community groups.
Using co-design to improve support for patients and families on the oral health pathway to improve their experience and reduce DNAs and theatre cancellations.

Project measures:
·      Patient experience: surveys, interviews, PALs, complaints
·      Appointment outcomes and cancellations: changes in DNAs, attendances, patient-initiated cancellations
·      Wait times: clock stops and starts
·      Cost-effectiveness: conversion of missed to active appointments

How is your project going to share learning?

Paediatric waiting lists and child oral health are nationally recognised issues. Our organisation serves a population of 2.4 million people across eight council boroughs. There are significant differences in health inequalities and life expectancy amongst our local population, for example there is a 14-year life expectancy gap for boys born at different ends of the same council borough. The challenges we are facing are likely to be replicated in other regions and learning from this project would be useful to both Q members and the wider healthcare system.
Avenues to share learning:
·      Q Community: Q exchange activities, Q Community blogs
·      National meetings & societies: Submitting abstracts and updates to BMJ journals, Royal College of Paediatrics, Royal College of Anaesthetists (RCoA), etc.
·      RCoA QI network: project lead is NW London Regional QI lead
·      Building on the informal network of NHS organisations and local government partners actively seeking to promote health equity.