NHS Waiting Times – building on good practice

When you are an auditor, sometimes the very nature of your job is to be critical.  It’s part of the territory and there are a number of good reasons why we have to be. Take the recent report on the Elective Waiting Times in NHS Wales; which was critical of the Welsh Government and the NHS.

It’s not an enjoyable part of the job, it doesn’t give us any sort of sadistic pleasure to criticise, and we do so because we care about helping to make things better. To help make things better, we cannot shy away from setting out what the problems are and why things have gone wrong.


However, it is not all doom and gloom and we are also keen to help to build on the good ideas and practices that we also found.   This is why I am delighted to talk about the Compendium of Good Practice we have recently released.

Sharing the Good Practice

Through our investigations we found that health boards are putting some interesting ideas into practice that can help to combat long waiting times. These include things like using technology like video-conferencing to avoid patients having to come into hospital, involving patients more in making decisions about treatments and improving care after operations.

We also looked beyond Wales to understand what good elective care looks like across the world. We have included the more interesting of these in our Compendium.  These examples include the fascinating approach to ‘frugal innovation’ in Bangalore, India and the NUKA system of healthcare in Alaska, USA.

These examples operate in an environment that is quite different from Wales.  But at the same time they point to important lessons about the ‘prudent’ use of limited resources to achieve better services for patients.


Moving forwards

We are conscious that publishing case studies is a helpful start but it is not enough by itself.

We need NHS bodies to use the examples to look at and challenge their own ways of working right across the elective care system. We’re certainly not saying that everybody should immediately try to copy and paste practices from one place to another, but we are saying they can provide inspiration and a guide to how things can be better.

To support that process of learning, we have distilled the findings of our report and our good practice examples into a checklist for health boards. We think it will be useful for staff right across the NHS.

In designing it we have tried to put ourselves in the place of an independent member of a health board, asking ourselves: ‘what are the questions I would need to ask to check whether my health board is doing the right things on waiting times’. We are planning to follow this work up with a series of workshops with independent members of health boards during the spring of 2015.

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So, what now?

So we went out and listened to what the public had to say about Waiting Times in Wales (You can read those findings in our Survey Results report here), we looked overseas and closer to home for examples of good practice in these areas and we distilled our findings into our checklist. But what now? Well firstly, we of course want to see the Welsh Government and NHS working together to act on our recommendations, now that they have been accepted.  Beyond that there are three things we want to see from the NHS in Wales going forward:

  1. Use our survey to inform their understanding of patients’ experiences of being on a waiting list – to build on the good experiences and address the things that contribute to patients having bad experiences
  2. Be inspired by the examples in our good practice compendium to re-think the way they plan and deliver services right across the elective system
  3. Use our checklist to test for themselves whether they are doing the right things to improve waiting times for patients

Mark Jeffs

About the Author

Mark Jeffs is a performance specialist with the Wales Audit Office. Mark’s recent and current work for the Wales Audit Office covers the review of NHS Waiting Times for Elective Care, the overview of NHS Finance and Performance, and he is currently working on a third Picture of Public Services report, which will provide an overview of the key issues facing public services in Wales.

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