In our last issue, we explained how systems should risk stratify the elective care demand profile based on where the most clinical risk sits (see diagram below). Using this risk profile would enable System Leaders to understand the entire demand profile for Elective Care, rather than simply those lists that are part of our national reporting cycle.
Crucially this last week, NHSE chose to only ask systems for the RTT PTL and the Cancer PTL. This would indicate that there is a lack of appetite at System level to consider the Elective care challenge through the lens of Clinical Risk. Rather, it suggests NHSE view the challenge as a Statistical Performance management issue.
Responsive regulation is always based on sound analytics, and effective System management also has to be based on robust understanding of data. With good data, progressive system managers can then target the appropriate actions from its constituent organisations.
Without asking for the entire data set for Elective care, system leaders are now at the mercy of the 3 “blind-spots”:
Despite not being asked for their entire data set by NHSE (at this stage), there is nothing to stop adaptive and progressive ICPs across the country working with their clinical leaders across provider organisations on increasing transparency. More importantly doing this will show a commitment to using clinical risk markers and clinical risk principles to manage Elective Care throughout the disruptive period caused by COVID-19.
We have compiled a suite of indicators that an Elective System Leadership function can use for the tracking of Elective Care at a system level. Once baselines are set, it could enable Clinical and Performance Management teams to use a common data set, to track performance and prompt actionable insights.
Why is this important?
Transparency across the entire elective care pathway will build trust with clinicians, and make them feel that they're working for an organisation with higher ethical standards. This is something System Leaders cannot take for granted.
Below we have listed a minimum elective care dataset that systems should use to monitor and risk stratify its waiting lists.
This list is by no means exhaustive and will need local additions depending on circumstances within each system.