Management of waiting lists

Question 1

Why are waiting times important to patients?

Answer 1

1. Patient’s condition may deteriorate
2. Experience of waiting can be extremely distressing
3. Patient’s family life may be adversely affected by waiting
4. Patient’s employment circumstances may be adversely affected by waiting
5. Excessive waiting times may be symptoms of inefficacies in the healthcare system and should be addressed as part of good management

Question 2

Why do we have waiting lists?

Answer 2

There is a limitless demand for health, people can always ‘be more healthy’ which creates a high demand BUT there are limited resources such as supply of money and staff which are finite

Question 3

What is the normal market response to a demand with limited resources?

Answer 3

The price mechanism - rationing by ability to pay

- This should be based on the ability of the patient to benefit from the care

Question 4

How do we measure waiting times?

Answer 4

• Average waiting time (mean or median)
• Proportion of people who waited longer than ‘x number of days’
• Average wait of people currently on the list

Question 5

Elective procedures to reduce waiting times

Answer 5

• Payment by results - fixed price fee for every patient episode
• Patient choice - patients offered choice of public or private sector
• CCGs - incentives for GP practices to avoid admissions

Question 6

Policies to increase the supply?

Answer 6

• Additional funding
• Increased productivity
• Booking patients
• Use of new providers
• Financial incentives to reduce waiting times

Question 7

Policies to reduce demand?

Answer 7

• Demand management: incentives for GPs (give resources for community based services), alternative services and walk-in centres
• Clinical guidelines that target resources and reduce unnecessary treatment
• Encourage use of private sector

Question 8

How can we manage waiting lists? Criteria for priority

Answer 8

• Clinical urgency
• Clinical severity
• Potential health gain
• Productivity and economic loss
• Equity waiting e.g. poverty
• Length time of waiting

Question 9

What are the future challenges and role of doctors in managing them?

Answer 9

• 18 week referral to hospitals! Requires >effort and still need to maintain clinical prioritisation i.e. don’t just treat to meet the target
• Changing priorities for NHS policies - increasing demand and financial restraint
• Changes in referral and treatment thresholds - as waiting times decrease, thresholds for referral and and treatment may also fall

Question 10

How can we improve waiting times?

Answer 10

1. Manage demand: ensure each referral represents the most appropriate decision for the care of that individual patient
2. Manage the queue: ensure the lists are well managed and patients are called in for treatment in an appropriate order
3. Manage capacity: provide efficient and effective services that meet the level of demand from appropriate referral
4. Provide leadership: ensure all parts of the NHS work together to achieve waiting time improvements