Prioritising the elective care waiting list in Coventry and Warwickshire

Ipsos was commissioned by the Strategy Unit (Midlands and Lancashire Commissioning Support Unit) to assist the work of University Hospitals Coventry and Warwickshire NHS Trust.

The author(s)

  • Reema Patel Public Affairs
  • Anna Beckett Public Affairs
  • Devina Sanichar Public Affairs
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Ipsos ran a 12-hour deliberation over two weeks with around 50 participants from across Coventry and Warwickshire. They were asked to explore their views on the development of an NHS waiting list prioritisation system, and the use of a range of factors to prioritise patients beyond length of wait and clinical condition. This report represents the findings of that deliberation.

The findings of the deliberation show:

  • Participants recognised the complexity of the challenge in prioritising waiting lists and defining fair outcomes. Participants were keen to achieve fairness, but each person had a different interpretation of how this would be realised. Some wanted to prioritise fairness of access, with people waiting in line depending on the clinical urgency. Others thought it would be important to consider how to achieve fair health outcomes – for example by letting the people who may take longer to recover have their operation first.
  • Participants acknowledge that waiting list prioritisation is no panacea for wider system issues– however, efficient and fair prioritisation could improve the system: Participants indicated that, beyond the prioritisation of the waiting lists, wider issues should not be overlooked and identified a number of ‘whole system’ priorities for tackling health inequalities. For instance, participants indicated the importance of the NHS focussing its attention on seeing everybody as quickly as possible, drawing in more resources and using existing resources more efficiently to get through the backlog, as well as their knock-on impacts on health inequalities.
  • Participants were more likely to accept factors involving individual health conditions for consideration in prioritisation. There were also a set of wider factors which most participants found to be important. Again, these related to the mental and physical health and abilities of patients on the waiting list. A number of factors were seen as more divisive and warrant careful consideration : A tranche of factors with some support, but which proved more divisive, included those relating to what some participants described as ‘social’ factors. Some people thought these were very important, but others were concerned that they could have unintended consequences for some groups of people.  Finally, there were some factors which only few participants thought should play a part in waiting list prioritisation or should be attributed much weight for a variety of reasons, such as ethnicity and lifestyle.
  • Ensuring that the waiting list prioritisation approach had adequate human and clinician involvement, and clinicians were supported to use the tools well: Participants discussed the challenge of ensuring that there is still human input into the prioritisation system, while maintaining a system free of bias.
  • Participants expressed significant initial concern about gamification, but on balance and following deliberation, felt that the benefits of improving the system outweighed these concerns: the range of responses and degree of concern expressed by participants at first around gamification illustrates the importance of developing waiting list prioritisation policies and procedures with clear transparency and public engagement at the outset.

You can download the report from the Strategy Unit website.

Technical note

The deliberation was conducted via four three-hour virtual workshops that were held with the public between 29 and 31 March 2022 and 5 and 7 April 2022.  There were around  50 attendees, in total, aged 18 years and older in the UK. The deliberations covered a range of public perceptions including: the complexity of the issue and the nature of the challenge; a deep dive into waiting list prioritisation; engaging with waiting list prioritisation factors and variables and applying the factors in practice.

The author(s)

  • Reema Patel Public Affairs
  • Anna Beckett Public Affairs
  • Devina Sanichar Public Affairs

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