Who'll take priority in plan to tackle Preston and Chorley hospital waiting lists?
There has been a call for clarity over how patients in Central Lancashire facing lengthening waiting times will be prioritised for treatment.
In common with the rest of the country, the area has seen a huge increase in the number of people who have been on the waiting list for over a year.
The total number of residents across Preston, Chorley and South Ribble whose wait has exceeded 12 months currently stands at 2.163, a meeting of Central Lancashire’s clinical commissioning groups (CCGs) heard.
That tally is up from just seven back in March – a 30,800 percent increase caused by pandemic-induced delays to non-Covid procedures.
Lancashire Teaching Hospitals (LTH) – the trust which runs the Royal Preston and Chorley and South Ribble Hospital – said back in August that all patients would be seen on the basis of clinical need rather than the length of their wait.
However, CCG lay member Ian Cherry said that the prioritisation process could easily cause unfairness.
“Unless a team of people are going to go through 2,000 patients with some sort of decision-making tool, we’re going to get inequalities of access.
“So if I’ve got cataracts, do I take priority over somebody who needs a hernia operation?” he asked.
CCG governing body members were told that the usual method of prioritising patients within different specialities needed to be rethought because of the sheer volume of the backlog in all departments.
“You’ve got to take a prioritisation view across the whole [list], because there are only so many theatres to deal with thousands of people waiting,” explained CCG chief officer Denis Gizzi.
“We’ve got to remember that people listed for treatment have already been prioritised [once]…but clearing backlogs of large numbers of elective patients will require some form of re-prioritisation.”
It is understood that a “validation” process is also taking place to ensure that all patients on the waiting list still require – and want – the procedures for which they were initially booked.
Helen Curtis, the CCGs’ director of quality and performance, said that the organisation – which is responsible for commissioning most hospital services for patients in Central Lancashire – would seek details from LTH on how “the different needs of individuals” would be taken into account.
“I don’t pretend for a second that’s an easy task for [the trust],” she said.
LTH chief operating officer Faith Button told a separate meeting of the trust board that Preston and Chorley hospitals were “focussing on protecting our clinically-urgent patients – our cancers and specialist surgery”.
Additional weekend working is being undertaken, along with use of the independent sector, but Ms. Button said that the loss of four day case wards – due to revised layouts to create Covid-secure areas – was also having an impact.
“Routine patients will still be an issue for a long time for us,” she warned.
That meeting also heard that much of the work to sort through waiting lists was being co-ordinated across Lancashire and South Cumbria by the region’s integrated care system (ICS) – the partnership of NHS and social care bodies for the area.
Weekly meetings of the medical directors of each of the hospital trusts in the ICS patch are being held, with the aim of offering “mutual aid” between different areas where possible.
Chorley and South Ribble CCG chair Dr. Lindsey Dickinson said that consideration could also be given to how to “reduce the flow of [new] patients onto waiting lists…so that [they] can be managed at primary care level where possible”.
However, her Greater Preston counterpart Dr. Sumantra Mukerji said that the ICS tools for prioritisation – “which are unknown to us” – could have unintended consequences for existing patients within Central Lancashire.
“If it transpires that a lot of our patients are waiting for minor things, then across the ICS, people from other [localities] might actually get preference – [something] over which we don’t have any control,” Dr. Mukerji warned.
The Local Democracy Reporting Service asked the ICS for details of its waiting list prioritisation process.
Gary Doherty, elective care recovery lead, said: “Hospitals across Lancashire and South Cumbria have been working together throughout the pandemic to make sure we are able to provide access to planned appointments and services, such as those for cancer.
“Measures are in place across hospitals, GP practices and pharmacies to allow people to access care safely if they need to be seen face-to-face. It is really important that people continue to attend NHS appointments.
“Working across Lancashire and South Cumbria, we continue to prioritise care as a health and care system, so that those waiting for appointments with most urgent needs and at most risk are able to access the appointments and care they need.
“This is particularly challenging as we respond to increasing demand as a result of Covid-19, which is why it is important local people do everything they can to help protect the NHS over the coming weeks and months.”