The Minister for Health, David Anderson MHK has announced that progress is being made in addressing waiting times, but that significant long term challenges remain. The announcement comes almost twelve months after the establishment of a Waiting Time Management Group, which has been tasked with a root and branch review of waiting times and how to tackle them; including looking at even closer integration of care across Noble’s Hospital and the community setting. The Department has initiated a number of specific steps, with initial results looking promising; but the Minister has made it clear that waiting times are likely to remain an issue for the foreseeable future as resources remain tight amidst the pressures of a growing and ageing population.
The Waiting Time Management Group, which is made up of both senior managers and clinicians, has identified several initiatives to help to reduce routine in-patient and out-patient waiting times – urgent cases already usually being seen within two weeks or less. The work centres on generating more capacity within existing resources, and reducing the number of patients who fail to show up for their appointments.
Work is still ongoing with some initiatives still at the pilot stage, but examples include:
- Validating waiting time data – ensuring that lists are accurate and that those on the list still require treatment. Also ensuring that waiting time data is properly managed and maintained going forward.
- Appointments Bureau – a centralised Appointments Bureau is to be established at Noble’s Hospital early next year, to act as a ‘one stop shop’ for patients to cancel, enquire about, and make appointments. This will streamline the service, giving patients a single point of contact whilst allowing previously ‘wasted’ appointments to be quickly reallocated to other waiting patients.
- Appointment reminders – text message reminder service currently being rolled out across clinics at Noble’s Hospital.
- Opt-in to appointments – patients take ownership of their appointment by confirming that they can/will attend, rather than only advising if they’re unable to attend.
- Service delivery methods – e.g. introduction of self referral for musculoskeletal physiotherapy service has eradicated the waiting list for this service with patients now treated within three working days. Similar techniques are being used to improve access to other services, such as tests and investigations, and there are future plans for other therapy services. The Department is also looking at online forms and e-services.
- Process design – reviewing processes under the Department’s ‘Fit4Future’ scheme, using Lean management methodology and holding Rapid Improvement Events, with the aim of reviewing clinical work patterns and administrative processes to increase productivity. Six integrated care pathways have been introduced for better joined-up working between Primary (community) and Secondary (Noble’s Hospital) care.
- Waiting time model – the Department has developed a technique to provide more accurate estimates of how long a patient will have to wait to be seen by a specialist at Noble’s Hospital, following referral by their GP.
Minister for Health, David Anderson MHK said: “Shortly after last year’s election and my reappointment as Minister for Health, I requested that a Waiting Time Management Group be established to investigate the current situation with regards to waiting times and any steps the Department could undertake to reduce these. 12 months in, it is clear that there is no quick – one size fits all – fix, and that the problem cannot be solved overnight, but the situation is starting to improve. Waiting time management is complex, and certainly something the Department needs to, and is, getting better at. But the pressures upon the Department and its services continue to increase. We have a growing population, generally we are living longer, and the field of health care continues to advance rapidly with new treatments and drugs.
“In the past the Department has undertaken specific Waiting Time Initiatives, providing funding for additional temporary clinical staff to clear, or significantly reduce, a waiting list. Whilst these are effective in the short term, they come at a significant cost and do nothing to address the underlying issue of meeting increasing demand. So the Department has spent the past year very carefully examining how we can do more with the resources we have – and although I am providing an update today, this work is ongoing and will continue. It has been made quite clear that we must work within our budget – the days of going to Tynwald for a supplementary vote for funding are behind us. We must live within our means, and I’m heartened to see that the tireless work by officers and clinicians at all levels over the past 12 months to examine the waiting times issue is starting to bear fruit.”
Overall, the Department estimates that work to date has increased throughput by 20%, with clear evidence that waiting times are falling in many areas, and continuing work should see them reduce further.
Member for Health Services, Dudley Butt MLC said: “The Minister and I understand the public’s concerns with waiting times – as do clinicians and managers. There is no single solution to waiting times. We are conscientiously chipping away at the problems, in a wide range of varying ways. Some changes are small, some are more radical, but together we believe that they will add up to make a tangible difference to patients and deliver more equitable waiting times. We know we have certain areas that need addressing such as ‘Endocrinology’ and ‘Dermatology’, and we’re working to address these. But whilst we have some areas of high demand and low capacity, we also have some areas where waiting times are exemplary – such as breast surgery. So yes, there remains much work to do, but progress is most certainly being made and the signs are that this will continue in the future.”
One example of a significant improvement is electrocardiograms, where capacity has been increased by more than 50% within existing resources, resulting in 431 procedures carried out in August 2012, compared to 198 in the previous month, with patients now seen within two months for routine appointments. A second example is the Respiratory Physiology Service, which had a did-not-attend (DNA) rate by patients of 31%. This clinic was used to pilot the new ‘opt-in’ appointments scheme, with the DNA rate being reduced from 31% to zero.