Q Exchange
Tackling inequalities in health of patients on surgical waiting lists
- Winning idea
- 2023
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'?
Local data demonstrates that patients in the two most deprived quintiles in Lewisham are waiting longer than patients in less deprived quintiles for elective surgery. Evidence suggests these groups of patients have already been disadvantaged before even getting to the waiting list.
Usual practice is for patients to have a pre-operative assessment before surgery. However, many patients at this point are deemed unfit for surgery causing further delays in access to care.
We will take a population health management approach to identify patients waiting for trauma and orthopaedic surgery who are at risk of experiencing inequity in access, experience and outcomes from health services. Patients are often not involved in designing approaches to address this challenge, therefore we will work with a cohort of these patients to co-design proactive interventions to support them, improving their health and optimising them for surgery, thus reducing waiting times and outcomes for these patients.
What does your project aim to achieve?
The overall aim of this project is to improve the health of patients on the elective waiting list who face inequalities in access, experience and outcomes from NHS services. The project aims to optimise patient’s health so that they are fit for surgery, and do not face further delays in accessing care.
We will identify patients at risk of experiencing inequalities based on agreed criteria (eg patients on waiting list living in most deprived quintile). Using a multidisciplinary approach, care plans will be adapted to help improve and optimise the patient’s health so that they are ready for surgery.
We know that there are barriers for patients accessing current services, and simply referring patients back to primary care is not going to improve patient’s health. We will use this funding to co-produce solutions with patients, helping improve current services and developing new interventions that meet the needs of patients.
How will the project be delivered?
The project will be clinically led by Dr Elizabeth Aitken, Clinical Lead and project managed by our QI and Strategy teams. Teams working on population health in Lewisham and SEL will also be involved.
We will fund local partners in the third sector who already have strong trusting relationships with our local community to co-produce the project and identify patients who would like to work with us to understand their experiences of using current services and the barriers that limit people’s access to and experience of these services. This will help us understand how we can better support patients through existing services.
There may be a need to develop new approaches to support these patients, for example joint clinic between lead consultant and a GP in a community health centre. We want to ensure that any interventions are co-produced with patients to ensure that they meet their needs.
How is your project going to share learning?
We have identified a number of outcomes for the project that we will be measuring, including improved clinical outcomes (eg optimisation of Haemoglobin), patient experience measures, and operational outcomes (eg reduction in number of surgery cancellations).
A wider aim of this project is to support the development of similar approaches within our ICS and wider NHS. We are fortunate to have a developed population health management tool with an elective waiting list dashboard in place, that other areas do not currently have in place.
Through this project we are aiming to identify proxy measures that can be used to identify similar cohorts of patients in systems which don’t have access to a population health management system.
We are also keen to work with other Q members to share learning both from using a population health approach and our experiences of co-producing new interventions for this cohort of patients.
How you can contribute
- Experience of optimising patient’s health on waiting lists
- Experience and lessons in how best to run co-production projects
- Ideas on how to share learning
Project updates
13 Mar 2024
There has been positive progress in establishing a population health management (PHM) approach to identifying a targeted cohort of patients to support to optimise their health ahead of surgery. We are using the elective care dashboard within HealtheIntent, to filter patients who meet defined criteria, including uncontrolled Hb and/or glycaemia, patients from the two most deprived quintiles based on Indices of Multiple Deprivation, patients with learning disabilities, patients with Serious Mental Illness (SMI), and those over the age of 65 exhibiting moderate/severe frailty, or having had two attendances at the Emergency Department, and living alone.
A multidisciplinary clinical panel has been established, including a Consultant Geriatrician, Anaesthetist, Surgeon, Allied Health professionals, and a General Practitioner. Patients are being reviewed using data within the PHM platform and with additional records within the acute electronic record system. Following discussion, patients are referred through the various pathways, with a new Pathway Coordinator supporting patients.
While it’s early to determine concrete outcomes, initial insights from patient reviews show promising results. Key findings include a diverse patient background, with 50% from ethnic minority backgrounds, 34% requiring anaemia optimization, 30% referred for frailty support, and 23% proceeding through usual pathways.
The financial support from Q Exchange is being used to fund a series of co-production workshops with patients to further refine our approach and consider other ways to support patients’ health. A project scope was shared with potential partners in October and we have now chosen a preferred partner and working through the procurement process to formally begin. We are now anticipating a series of workshops being held over February to April.
We are also in the process of extending the project to include patients from additional specialties, including ENT and General Surgery, as well as expanding into Greenwich.
Comments
Adam gregory 2 Jun 2023
This is a very forward thinking project with potential to have positive impact through pathways and onward sustainability. These are qualities aligned very much in our bone health project, where we are reaching out to groups that may be at higher risk of missing out on opportunity for bone health screen post fragility fracture, such as Learning disability patients, those with long term neurological conditions, or strangely enough generally the male population with a presumption among some that Osteoporosis does not affect male patients. The ED&I factor within our project in what in some areas is a fairly deprived area of South East London seems to also align here, good luck, Please add any support for us you are able, thanks!
Eric Barratt 1 Jun 2023
This is an excellent project proposal which will no doubt improve patient experience and outcomes.
I think sharing learning widely will be particularly useful and would suggest working with the health innovation network to support this.
Rhoda Iranloye 25 May 2023
This is such an important issue and the link between co-production, population health and reducing health inequalities when it comes to access is great to see.
Beckie Burn 26 May 2023
Thank you Rhoda - absolutely and having some additional resource for the co-production work would make such a huge difference, fingers crossed!
Emma Sutton 18 May 2023
This is such an important issue. We are also based in an area where there are high levels of deprevation. I can see that understanding patient experiences of using current services and the barriers that limit people’s access to these services will be a demanding piece of work. To really understand how we can better support patients through existing services there many be many steps needed and the recognition that each step may take a lot of time? For example, building relationships with communtiy faith groups, building a PPI panel, translation, etc. It will be a fascinating and really in depth piece of work.
Beckie Burn 23 May 2023
Hi Emma
Thanks - yes definitely, this would really enable us to focus on that co-production piece and take the time to do it properly. Would love to understand a bit more about your area and challenges and whether there is any shared learning!
Beckie
Jennifer Illingworth 26 Mar 2023
We are looking to do something similar in NW London following analysis of our waiting list - it would be great to share ideas & approaches! Agree it's really important to also consider the disease burden of patients on waiting lists and how this acts as a barrier to treatment.
Beckie Burn 27 Mar 2023
That would be really helpful! Send me a message with your contact details and I'll link you to the team and clinical lead who I'm sure would love to be in touch.
AMIT PATEL 21 Mar 2023
I think this sounds like an excellent initiative and explores an area that hasnt perhaps had as much input in the past. Our own project is trying to provide an outreach service for a deprived patient population with ventilatory failure. I am sure we could learn from both approaches!
Beckie Burn 27 Mar 2023
Thanks Amit, yes definitely it would be good to be in touch and share learning across the work. Please feel free to message me directly.
Adrienne Lee 12 Mar 2023
Hello! I am also looking at helping patients wait well and reducing inequitable waiting times for procedures and surgeries, but with a focus on learning disability. Should we try and e-meet and look at sharing ideas?
This is my Q Exchange idea submission - https://q.health.org.uk/idea/2023/reducing-inequitable-delays-for-procedures-for-learning-disability-patients/
Beckie Burn 15 Mar 2023
Yes this would be great, I'll contact you to set something up
Joel Reynolds 10 Mar 2023
Really like the population health approach proposed here, and the recognition of how important co-producing solutions with patients needing the service will be.
One challenge we have found working in a similarly dense urban area is that local postcodes can contain a wide range of housing stock and variance in need.
Involving residents, community services and groups throughout should help understanding of the local experience, alongside the population data of IMD quintiles. It will also be essential for designing effective solutions to any health inequalities identified.
Beckie Burn 15 Mar 2023
Thanks Joel, absolutely - we also provide community services in Lewisham and therefore have some good connections into local communities but we are really keen to think about who we are not reaching, even through working with community groups, as often this is the population that needs the most support.
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