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How a digital approach has tackled health inequalities among ethnic and vulnerable patients

Significantly longer waiting times for elective surgery among certain patient groups, particularly those in ethnic communities and areas of deprivation, have been dramatically reduced thanks to digital innovation between a health trust and the informatics service it hosts.

Analysis carried out by The Health Informatics Service (THIS), which is hosted by the Calderdale and Huddersfield NHS Foundation Trust, found that in May 2021 patients from a minority ethnic background were waiting almost eight weeks longer, on average, than white patients for a ‘priority two’ (P2) operation – which NHS guidelines state should be treated within a month of prioritisation.

It also found patients from the most deprived communities were waiting 8.5 weeks longer than those from better off areas, prompting leaders at the trust, which runs Huddersfield Royal Infirmary and Calderdale Royal Hospital, to turn to THIS for a digital route into solving the issue.

Digital interventions created and implemented by THIS through its collaboration with the trust’s executive team, performance analysis staff, general managers, senior clinicians and appropriate information staff resulted in waiting lists for ethnic minority patients dropping by almost five weeks on average within six months, while those from deprived areas saw the wait cut by an average of six weeks.

Since then, average waiting times for both groups have virtually been eradicated and the digital prioritisation markers are being applied to patients with other characteristics, such as learning disabilities, frailty, obesity and mental health issues.

How the improvements were achieved

Calum MacIver, THIS’ Corporate Information Manager, explains: “Our Information Team started pulling together figures from our data warehouse into the trust’s business intelligence platform, referred to locally as Knowledge Portal+ (KP+), using Qlik Sense and added in nationally available data, such as population information, deprivation and census data.

“This led to a larger, all-encompassing health inequalities model, where markers were attached to patient data at source. It created a new method of looking at waiting lists, that didn’t just examine total numbers but started to factor in the data from the perspective of the different patient characteristics, and it has created a new culture within the trust and us, where we take account of inequality in everything we do.”

The results were achieved with the following, extensive, set of measures:

  • Review and improved data quality.
  • Analysis of waiting time data.
  • Reviewing waiting times across pathways to establish points of divergence.
  • Dedicated contact team established for scheduling patients.
  • New pathways being developed.
  • Weekly inclusion of data in leadership briefings in addition to internal and external engagement.
  • Clinical reference group established and dataset by specialty and consultant developed.

This has led to the introduction of individual patient planning, a new care pathway in the trust’s electronic patient record, where a flag identifies patients on referral. Individual priority pathways for patients with a learning disability is sustaining the change, as is a children’s waiting list validation and prioritisation, and dedicated vaccine clinics.

The collaboration is now exploring:

  • Cancer activity profiles and waiting list addition trends.
  • More closely involving clinicians in the data analysis process.

Winning plaudits and attracting attention

The work done by THIS, and its host trust has been included as an exemplar case study in the NHS Healthcare Inequalities 2022/23 planning guidance advisory note, which says: “The analysis of the data contributed to the inequalities being cut significantly...Other systems could adopt a similar approach, making use of the Health Inequalities Improvement Dashboard (HIID).”

It goes on to say, “The total waiting list size, including disaggregation by deprivation and ethnicity, as demonstrated by this work should be included in the Key Performance Indicators to be assessed”.

The work has also attracted interest from NHS colleagues across the UK, while the West Yorkshire Integrated Care Board has put together a business case to provide a project management resource to facilitate sharing the learning and supporting similar implementations where required across secondary care trusts.

Further enhancements include the development of a prioritisation matrix – that applies a vulnerability score at an individual patient level when considering their care pathway, and increased informatics and project support dedicated to health inequalities.

Calum MacIver adds: “A representative from the Information Team now attends monthly meetings of a learning disability group to share knowledge and gain greater understanding from key stakeholders.

“A further ripple effect is work now taking place within the trust to specifically look at inequalities among asthma sufferers, and a community-based project is working with primary care stakeholders in a highly deprived area of Huddersfield, again to share knowledge and gain better understanding to influence positive health outcomes in the area.”

Innovation and collaboration

In addition to CHFT, The Health Informatics Service enables new, empowering, efficient and secure communications and IT services for clients including other health trusts, GP practices, laboratories, hospices and care charities. If you are interested in working with THIS, visit its website here.

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