Document for PDF - Ministry of Health

Clinical Issues and What We are Doing
Waiting Times: Patient Focused
Care
Issues
The waiting times project is an innovative and
international first, a project to bring order to one
of the grey areas of health management.
Historically, decisions about who gets elective
surgery have been poorly prioritised and sometimes
distorted by relying on individual judgement or a
specialist’s power in a hospital. The project puts
nationally consistent systems in place, based on
clinical criteria, to make sure that those who most
need surgery get it first.
Correct ordering of priority means that any
additional money that comes into elective surgery
in the health sector does the most good possible.
The principles of the project are as follows:
• Patients should know when, where and what
treatment is available to them within a fixed
period of time.
• Everyone, regardless of location, is entitled to
the same level of service to address the same
level of need and ability to benefit.
• Timely access to first assessments and services,
and elective services prioritised on a fair,
transparent and consistent basis nation-wide is
required.
There is now significant acceptance of the project
by clinicians and providers. Major system
implementation has taken place. Great effort has
gone into developing nationally consistent criteria.
Draft national clinical priority tools are currently
being circulated.
The waiting times project raises a number of
important ethical issues about urgency of need
versus ability to benefit. In practice, however,
clinicians take a practical view of what needs to be
done in developing the clinical priority criteria.
We are in the early phase of development so the
monitoring and evaluation aspects are important.
Diagnostics and some follow-up checks are being
devolved to primary care, leaving money and time
for hospital clinicians to improve further the
elective surgery situation.
Personal Health’s Action
The formation of clinical working groups draws
on professional and patient groups to develop
nationally consistent prioritisation tools to:
• Score new patient inflows.
• Re-score patients scored under regional tools.
• Adjust local access thresholds to the new
scoring system.
• Progress from regional use of tools to national
consistency.
Our progress has been faster than anticipated for
the implementation of the clinical criteria.
There has been a substantial commitment from the
medical community to development of these tools.
We have developed a robust strategy to measure
waiting list outcomes, using booking system data
to ensure alignment with hospital need and capacity
issues, determining more accurate financially
sustainable thresholds by hospitals.
In addition, provision of audit and monitoring
processes will ensure quality improvement in
hospital data collection systems.
The system is not fully developed. We are now able
to look up and down the country to identify the
hot spots. We still do not fully understand the
patient flows enough to give a firm view on the
gap between what we currently are able to purchase
(the financially sustainable threshold) and what we
would like to purchase (the clinically sustainable
threshold).
HFA Improving Our Health 27