NHS waiting lists are back in the news headlines thanks to a major speech last week by the Prime Minister Kier Starmer, where he set out his six key milestones for government.

What, though, was announced in the PM’s reset speech from a healthcare perspective? And, more importantly, what does the new health milestone mean for Trusts when it comes to getting to grips with their waiting lists?

We delve into the detail and outline why a focus on the individual, and the extent of the recovery challenge, will really help to bring waiting lists down at long last.  

Focusing on the micro details

Starmer revealed the government’s intention to deliver a reduction in waiting lists and waiting times for routine hospital care. Its new health milestone will aim to ensure that 92% of patients are waiting no longer than 18 weeks from referral to start of treatment by the end of 2029, a level last witnessed in 2015.  

For the last few years, the commentary on elective waiting lists has been primarily concerned with the macro level figures – e.g. the overall size of the elective waiting list and the national proportion of patients not being treated by the 18-week point.  

However, in order to plot the recovery needed, work now needs to focus at a much lower level of detail. Not just at ICB or provider level and not just at individual service level, but at individual waiting list and pathway stage.  

When the 18-week standard was introduced, it was commonly understood that most pathways would need to broadly conform to a three-phase ‘6-6-6' week timeframe. This means the three key stages of a patient’s elective care pathway should each take circa 6 weeks – first outpatient appointment, diagnostic tests and inpatient/day case or other treatment intervention. This, in the most part, is still a relevant yardstick today. Pathways and their milestones have evolved, but what remains fundamentally important is understanding your service-specific targets for, as a minimum, the first outpatient appointment wait and the inpatient or day case admission wait (where applicable).  

What does this mean in practice?

For argument’s sake, if you assume that in order to meet the 18 weeks standard both of these phases of the pathway need to be a 6 week maximum wait, the question then needs to be: “what do I have to do to reduce waits from where they are now to 6 weeks?”

The answer lies with understanding what a sustainable list size for that pathway stage is. The logic goes that, once you can reduce the size of the waiting list to its sustainable point and maintain a balance between demand and capacity, you can then be assured that you can add and remove patients to and from it inside of the necessary target times.  

Once you understand the sustainable waiting list sizes, you are then able to understand how much beyond this point you are and how much reduction is required – i.e. the amount of additional activity needed in the short-term for recovery. Once this has been effectively planned, you are then well-placed to understand the trajectory and timeframe for recovery.  

In summary, the requirements are:  

1. Target waiting time: the maximum amount of time a patient can wait at each pathway stage (or on each waiting list) in order to meet the overall waiting time standard;  

2. Sustainable waiting list size at each stage: the maximum size to which the list can grow in order to deliver the target waiting time; 

3. Waiting list excess – commonly called the backlog: the difference between the current waiting list size and sustainable list size.

Finally, and perhaps most importantly, you need to be assured that ongoing capacity and demand are in balance. In other words, you have sufficient permanent capacity to service the ongoing demand and ensure that the waiting list does not grow again.  

This should be the basis of any recovery plan. What is important is that this process needs to be understood for each key pathway stage of each relevant specialty. In order to accurately understand some of the variables, it may also be necessary do some additional modelling work (i.e. demand and capacity).

If the government is serious about hitting its health milestone, it needs to shift focus from the macro to the micro – only then will we start to see a difference.

Want to understand more? Want a clearer insight into what your waiting list recovery challenge looks like? We’ve created a waiting lists calculator which outlines this very thing. You can find it here.

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