Why waiting list initiatives don’t work
15/12/2014by Rob Findlay
(First published at Roy Lilley’s NHS Managers eNewsletter.)
Seasoned NHS managers know from long and unhappy experience that waiting list initiatives don’t work.
Or, more accurately, they often seem to work at first. But when the extra work comes to an end, everything steadily goes pear-shaped again.
The English national waiting list initiative is a topical example, but a similar story can be seen in waiting lists all over the UK. The main features are:
- The waiting list is growing steadily, which means that treatments aren’t keeping up with demand. But the waiting list initiative provides only non-recurring funding to cover a one-off surge in activity.
- The waiting list has an extended ‘tail’ of long waiters, which indicates that patients are being scheduled out of order. But the waiting list initiative aims to just ‘chop the tail off’, without addressing the underlying booking processes.
- The national waiting list has another feature too: it is made up of thousands of smaller waiting lists, all with different waiting time pressures. But the waiting list money was dished out according to the number of long-waiters on each list without a serious attempt to evaluate the underlying pressures.
As it turns out, the £250 million allocated to the national waiting list initiative is not delivering much in the way of even short term benefits. So what does a proper solution look like, for a long national or local waiting list?
First, you need to get the baseline right. If you keep up with demand in every service, and stop the waiting list from growing long-term, then at least the problem won’t get any bigger.
Second, schedule all patients according to clinical need and natural fairness. This is a big subject, and includes abandoning perverse targets that restrict hospitals from treating their longest waiting patients.
Only then will the third thing make a lasting difference: that’s the waiting list initiative. It shrinks the total waiting list to the point where short enough waits are sustainable. And because the baseline activity and scheduling are right, those waits will stay short.
And if you just skip to the waiting list initiative? A few months later, you’ll need another waiting list initiative.
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