Waiting List Modelling: Effectively Achieve Elective Targets

Meeting national targets for elective treatment in the wake of COVID-19 has been challenging for Trusts across England

The impact of Covid-19 on the delivery of elective services has been substantial: waiting lists have built up, with a sizeable backlog of patients waiting longer for treatment than ever before, and referral volumes have returned to levels which exceed the pre-pandemic norm.

Trusts must deliver NHSE expectations around waits to treatments and sizes of waiting lists, and to do this need a robust understanding of required capacity and efficiency levels, as well as the impact of future known interventions and referral volumes.

Staring in November 2022, Edge Health worked with Leicester, Leicestershire and Rutland (LLR) Integrated Care Board to support with operational decision-making and elective care planning to meet these targets.

Our approach involved working closely with system leadership in LLR to draw out insights from acute, community and primary care provider data

Our objective was to support stakeholders to clearly articulate the gap between current capacity, demand and delivering NHSE targets, to a range of audiences and forums. This allowed the system to proactively identify areas of pressure, develop a plan and set of scenarios and track progress relative to expectations.

Using simulation modelling and demand forecasting techniques, we built a robust understanding of the impact of system-wide interventions on waiting list projections. We proactively identified areas of pressure and followed up with demand & capacity deep-dives for 4 specialties and 9 diagnostic modalities.

The outcome was drastically improved waiting times to elective treatment, following informed, evidence-based system and Trust-level leadership and investment decisions

The sole acute provider in LLR improved from being 3^rd worst-performing Trust for 92^nd percentile waiting times and proportion of patients waiting over 65 weeks for elective care, into the top 50% of Trusts for both measures[1]. Total waiting list size has plummeted, with LLR on-track (again in the top 50% of Trusts) to meet the March 2025 target of no patient waiting over 1 year for treatment.

Our analysis provided the evidence base to support LLR system and Trust-level leadership with cohesive decision-making and strategic planning for the future. We helped a range of stakeholders to understand risks and focus on the most likely scenarios, and the scale of intervention and investment required to proactively reduce pressure on elective services.

[1] Referral to Treatment National Data Collection. Compared November 2022 to March 2024.