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System-wide Management of Elective Waiting Lists

The Phase 3 letter at the end of July issued a clear direction of travel in relation to the management of elective waiting lists at system level.  It placed an emphasis on ensuring equality of access for patients and an effective use of resources across the system footprint. This was further backed up in the following weeks with the confirmation that both activity baselines and funding envelopes would be determined and awarded on a system level.


Whilst some systems were beginning to explore how system level waiting lists would be developed practically ahead of the pandemic, the detail surrounding how to achieve this was probably best considered as emerging.  Now systems face the challenge of delivering the requirement at pace along with some of the most ambitious recovery planning that they are likely to have ever undertaken.


The challenges to developing and embedding the requirements can be set into three broad categories: technological, operational processes and oversight & success criteria.  Beyond this are a number of more existential issues with what the policy position implies, particularly regarding how to identify and utilise genuine excess capacity and how to manage messaging to, and expectations of, patients regarding moving between different providers.


Solving the technological challenge


The task of merging the waiting lists of distinct providers is potentially the most straightforward of the challenges if the right technological solution is implemented but certainly the factor which will cause most damage to a system’s efforts if the reverse is true. There are different options available which range from provider Trusts sharing the same incidence of a PAS/EPR to implementing a third-party tool which aggregates the various data and provides a ‘virtual’ merged PTL.  In reality, there are few systems which have to date wanted or needed to ensure a common platform between providers and therefore it is likely that some method of extracting and combining waiting list data will be required.


Inevitably different systems will employ different approaches, and this is not necessarily a bad thing provided that there are consistent standards and deliverables across the different methods.  First amongst these clearly is that the approach is safe; the potential for groups of or individual patients to be overlooked, inappropriately deprioritised, or simply lost is very real. Unfortunately, this risk has been realised consistently when providers alter their own system architecture even at a single site level and with comparatively generous timescales and pressures than we see now.  Similarly important is that the approach is practically manageable; duplication or double entry and multiple versions of the same data will signal the rapid end for engagement with the process.


At Acumentice, we have previously led the implementation of a digital patient management system (Qubit Health) at Imperial Healthcare NHS Trust which offers a PAS agnostic aggregation of PTLs.  This approach has been extremely successful in creating efficiencies in managing several PTLs across this large and complex organisation.  Recognising the current need, we have been working with our associates at Qubit Health on further enhancing this system to support, among its various features, the aggregation and management of a shared PTL across a system.


Operational and process challenges


Alongside the job of getting all the information in one place is the project of developing a set of standard operating procedures which allow a diverse set of teams to continue the myriad tasks associated with managing it.  Booking and scheduling of patients takes on a very different flavour when it is done at system level and at a significant extra level of complexity if we assume that it remains a task carried out by local teams at each site.  Whilst centralising booking and scheduling at system level would be an option, the reality is that this will unlikely be a route taken in the short term.


As well as ensuring the process supports teams working on a single PTL collaboratively, systems will need to fix and communicate any changes to scheduling priorities from the outset to ensure a consistent approach is taken.  Where a technological solution does not provide an immediately updated waiting list position, the success of the logistics and communication of booking progress will be pivotal.  Many areas will have experience of outsourcing to the independent sector and associated memories of complex and time-consuming administration; clearly, a bad outcome would be any system that replicated some of these intricacies on a bigger scale.  Fortunately, outsourcing has played a big part in the previous phases of the NHS response to COVID-19 and the opportunities for smoothing out processes which will form part of this, as well as the continued use of the independent sector, have been plentiful.


Determining success


In the absence of the headline measure of performance being applied in a meaningful way, success for elective care in the next few months will be solely determined by the activity targets set out by the phase 3 letter.  Many of the indirect measures that organisations have previously used as part of a sensible suite of success indicators will still be relevant, if in need of a mild reimagining.  Efficiency and maximising use of capacity is naturally going to be important, however some of the existing assumptions as to what is achievable will need remodelling to reflect the entire system’s capacity.


A reduction in the overall system PTL size, and the corresponding reduction in long waiting cohorts, would also be considered good outcomes, however this would need to form part of a compound measure which also protected against pockets of inequity developing in certain services or certain parts of the system.  Importantly, as assessments are made by clinicians in each system, what is considered inequitable and what is considered an unfortunate but otherwise relatively safe consequence of the circumstances remains to be seen.


Ultimately, facilitating individual Trusts’ access to additional capacity and wider support across the system is a welcome step.  Assuming the capacity itself can be released, a successful implementation of a system level waiting list will increase the likelihood that priority patients will be seen more quickly and serve to reduce risk.  It also comes at a time when it provides a further incentive to system leadership teams to build on their collaborative working and to capitalise on the positive moves in that direction that this year has brought about.

Philip Purdy

Senior consultant with Acumentice

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Inspirational Woman: WeAreTechWomen

Pioneer in championing women in the workplace and technology, WeAreTechWomen has today published an article featuring our managing director, Karina Malhotra, as this week’s inspirational woman in tech.

This Q&A highlights why making a positive difference to the healthcare sector has been a long passion of Karina’s, why she founded Acumentice and some top tips for any budding entrepreneur.

Click here to read more.

Covid-19 instructions for self-isolating as part of the response to the pandemic

Elective Care in the Third Phase of the NHS Response to the Pandemic

Arriving at the end of July, the letter to systems setting out the third phase of the NHS response to Covid-19 was the first time expectations for recovery and restoration were prescribed. Significant and rapid acceleration of non-Covid activity over the course of the next three months made up a major part of these priorities.


The phase 3 letter sets out the expectation that trusts and systems should deliver at least 80% of their previous year’s activity for both overnight electives and for outpatient/day case procedures in September, rising to 90% in October and aiming for 70% in August. It goes on to recognise that this requires a return to at least 90% of the previous year’s levels of MRI/CT and endoscopy procedures, with an ambition to reach 100% by October. Finally, there is a need to reach 100% of the previous year’s activity for first outpatient attendances and follow-ups from September and through the balance of the year. Based on the latest national figures (June 2020 HES, specific acute) there is a significant gap to make up to achieve the target milestones, with day case and ordinary admissions both sitting in June at around 45% of September 2019 levels and first outpatient attendance and subsequent outpatient attendance at around 62% and 72% respectively.


As they stand, the current expectations are not set in terms of either a target RTT performance percentage or waiting list size, but in terms of plain activity. The removal of the complexity of planning to achieve a performance standard and/or waiting list size target in this phase of the NHS’s recovery is a good thing, activity is the easiest unit of measurement to work with. This represents a shift away from previous recovery drives and perhaps demonstrates a very necessary injection of pragmatism considering the scale of the challenge. That said, within the detail of the planning returns, there is an expectation to provide total RTT waiting list figures and over 52 week waiter numbers on a monthly basis. So, when planning, it will still be important to isolate clock stopping activity from other planned activity. This will need doing at quite a granular level when determining each set of actions required and their impact.


The pre-existing prioritisation principles for elective care remain unchanged, namely high clinical priority (urgents) first, followed by the longest waiters in RTT pathway chronological terms.  As a result, there are two different goals that need to be considered equally important throughout the planning phase and beyond: seeing and treating enough people (to meet 2019 levels) and seeing and treating the right people (to limit the growth of long waiters and ensure a clinically appropriate distribution). What each clinical service takes to understand as a clinical priority is of course an emerging concept in late summer 2020.


So where to start? Despite the 21st September deadline for the submission of system plans, this will inevitably be an iterative process. Providers may wish to prioritise understanding where (in which specialties) these milestone activity targets are more and less achievable considering: the starting point (current levels of activity achieved throughout phase 2) and the nature and complexity of any extraordinary measures necessary to meet existing and required levels of activity – i.e. understand the barriers at an early stage. Those barriers may also be helpfully expressed in clear and consistent categories allowing for the task of meeting their various challenges to be distributed appropriately across different parts of the system: e.g. in terms of estate restraints, staffing, clinical pathway barriers etc.


There is a clear direction in the phase 3 letter to make use of alternative options for generating capacity, in some cases these efforts will aim to free up more traditional capacity options and in others to replace the face-to-face appointments which provide an ongoing risk to be managed in relation to the virus. Systems will want to work as a priority to develop local protocols and identify appropriate opportunities for increased use of advice and guidance routes to prevent onward referrals and ease the pressure as well as implementation of patient initiated follow-up (PIFU) and expansion of telephone/video OPAs in order to provide capacity release elsewhere in the service. On top of this, maintaining and going further on independent sector capacity utilisation from both an outsourcing and insourcing perspective will remain key.


Communication with patients will be paramount; there is clear expectation that those whose treatment has been affected by the pandemic are contacted and informed of next steps. This will take a significant coordination between primary and secondary care and establishing how to go about this will be another early priority. Providers may also wish to use the opportunity of contacting patients to review their clinical circumstances and implement different options for their onward pathway depending on the outcome.


One thing that is clear is that the need for accurate and accessible data will be essential at every turn. From understanding the detail of last year’s activity figures, to the ability and capacity to deliver those levels in the coming weeks; from effective clinical prioritisation to understanding the capability for outsourcing and alternative capacity options; and from identifying and reassuring those patients who have been delayed to the waiting list management techniques required to make a sustainable impact on an already fundamentally challenged sector of the NHS.


Thinking ahead, perhaps to “Phase 4”, the ask ahead of November for elective care is described as a ‘window of opportunity’ and so the assumption remains that there is a distinct possibility of a suspension of elective activity again over winter (this would be consistent with the last few winters irrespective of the pandemic). For now, success appears to be returning to pre-Covid levels of activity for a time, but two sizeable problems remain when we recall that September 2019 levels of activity were not sufficient to keep pace with demand twelve months ago. Firstly, how to make headway into the additional backlog caused by successive months of scaled back elective activity and secondly, how to meaningfully return to the task of taking a full and complete view of the scale of the problem for elective care performance, a task that was arguably overdue this time last year.



Philip Purdy

Senior consultant with Acumentice

Headshot of Philip Purdy, Principal Consultant at Acumentice

Philip Purdy joins Acumentice

Acumentice is proud to announce the appointment of Philip Purdy to the team as senior consultant.

Philip’s career has predominately been in the NHS and he has taken many senior positions in non-clinical roles, most recently at NHS England. His wealth of experience and knowledge makes him extremely well placed to join the existing team of expert consultants and support the organisation on their mission to provide high-quality support to the NHS and creating positive, sustainable change.

Read more here


An example of data modelling on a screen

HSJ Feature – Exploring how Elective Care Demand and Capacity Modelling must take a new form

Amid an array of new complications, historic models for elective care will need to be reimagined and patient safety remain a guiding principle, argues our founder, Karina Malhotra.

As a direct consequence of the Covid-19 pandemic, elective care waiting lists are longer than ever before. As the NHS begins to recommence elective care, it is vital to consider innovative approaches to enable an efficient and successful recovery whilst maintaining patient safety at the core.

In this article we explore which tools and resources should receive focus – in particular we discuss the importance of data quality and scenario-based capacity planning. The article also highlights how these may need to be adapted to respond to the uncertainty still present in the healthcare landscape where the pandemic continues to have a very real impact.

Acumentice prides itself in approaching elective care recovery with bespoke and innovative solutions to suit each NHS organisation’s unique needs.

Read the full article here


The front of a Covid-19 advice booklet

HSJ Feature – How Managing Data Effectively now is vital for Elective Care Recovery post COVID-19

As NHS leaders begin to think about recovery after the pandemic, it is vital to take appropriate actions now to prepare for the expected growth in elective waiting times and the potential impact on patient safety, writes Acumentice Founder Karina Malhotra in the HSJ.

Data quality within the elective care waiting list may not seem to be the top priority right now; but we, at Acumentice, believe that it will play a significant role in Trusts’ recovery efforts. More importantly, to patients’ outcomes and their lives. When the fog of war from the coronavirus has lifted, every Trust is likely to be facing increased waiting list sizes holding more long waiting patients with potentially deteriorating health conditions.

The challenges Trusts will face, as well as some of the most effective actions we are working with our partners on to help aid their recovery are discussed.

Read the full article here


International Women's Day logo 8th March

The Importance of Diversity in the NHS

Our Founder Karina Malhotra writes in the European Business Magazine on The Importance of Diversity in the NHS.

This month as part of feature on senior women in leadership across Europe, Karina shares her views in the European Business Magazine on the importance of harnessing the benefits of new technologies and a more diverse workforce to drive healthcare improvements in the future.

The article showcases Acumentice’s commitment to supporting healthcare systems meet the ever increasing needs of our patients in a sustainable and effective manner, along with our belief in embracing diversity and innovation to ensure care is patient focused and equitable for all.

To read the full article please click here


Operating table and vital signs monitor

Trialling Qubit as a COVID-19 Tracking Solution

As part of Acumentice’s commitment to supporting our clients through the current Coronavirus crisis, we have partnered with one of London’s leading Trusts to trial the use of our partner product Qubit as a tracking and reporting solution for management of infected patients. Currently the software is being trialled as a means to track infection status, test results/dates, cancellations and outcome recording from telephone/video clinics

For more information about how Qubit can help support your services please contact us at

A visual representation of the Covid-19 virus

Acumentice supporting Trusts through COVID-19

As confirmed COVID-19 cases continue to rise across the UK, the pressure on our healthcare system continues to increase and gaps in hospital workforce are causing challenges to meeting the crisis.

Acumentice are committed to supporting our clients through this difficult time and are coordinating additional capacity for filling staffing gaps, both on site and as remote working teams.

Key support available:
• Both front line administrative placements and interim senior management candidates are available immediately to fill gaps self by substantive staff having to self isolate and support can also be provided to arrange secure remote working solutions for your staff.

• Training, floor walking and upskilling support on PAS systems are available for staff redeployed across departments, volunteers or retired NHS staff returning to work.
• COVID related data tracking support is available with through digital or manual processes
• Elective care project / programme management, including OPD virtualisation, triaging and cancellation management

If your services need support during this crisis please get in touch at

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Acumentice Celebrate being awarded Major Public Sector Framework Inclusion

Acumentice are proud to be part of a select group of companies approved for the London Procurement Partnership (LPP). This reflects the trust the LPP have in our services and the value they offer and should allow more rapid deployment of solutions to our clients.

We have been awarded a Framework Agreement RM6008 Management Consultancy Framework 2 (MCF2) Lot 1: Business consultancy services.

We look forward to working with more NHS Trusts and other public bodies through the LPP, supporting them with their RTT waiting times and data quality challenges.

For more information about accessing Acumentice services through the framework please get in touch at